{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T01:39:13Z","timestamp":1789954753131,"version":"4.0.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2009,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The object of this study was to report the clinical features, surgical treatment, and long-term outcomes in adults with moyamoya phenomenon treated at a single institution in the US.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Forty-three adult patients with moyamoya disease (mean age 40 \u00b1 11 years [SD], range 18\u201369 years) were treated with encephaloduroarteriosynangiosis (EDAS). Neurologists examined patients pre- and postoperatively. Follow-up was obtained in person or by structured telephone interview (median 41 months, range 4\u2013126 months). The following outcomes were collected: transient ischemic attack (TIA), infarction, graft collateralization, change in cerebral perfusion, and functional level according to the modified Rankin scale (mRS). Kaplan-Meier estimates of infarction risk were calculated for comparison of surgically treated and contralateral hemispheres.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The majority of patients were women (65%), were Caucasian (65%), presented with ischemic symptoms (98%), and had bilateral disease (86%). Nineteen patients underwent unilateral and 24 patients bilateral EDAS (67 treated hemispheres). Collateral vessels developed in 50 (98%) of 52 hemispheres for which imaging was available and there was evidence of increased perfusion on SPECT scans in 41 (82%) of the 50 hemispheres evaluated. Periprocedural infarction (&lt; 48 hours) occurred in 3% of the hemispheres treated. In the follow-up period patients experienced 10 TIAs, 6 infarctions, and 1 intracranial hemorrhage. Although the hemisphere selected for surgery was based upon patients' symptoms and severity of pathology, the 5-year infarction-free survival rate was 94% in the surgically treated hemispheres versus &lt; 36% in the untreated hemispheres (p = 0.007). After controlling for age and sex, infarction was 89% less likely to occur in the surgically treated hemispheres than in the contralateral hemispheres (hazard ratio 0.11, 95% CI 0.02\u20130.56). Thirty-eight (88%) of 43 patients had preserved or improved mRS scores, relative to baseline status.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this mixed-race population of North American patients, indirect bypass promoted adequate pial collateral development and increased perfusion in the majority of adult patients with moyamoya disease. Patients had low rates of postoperative TIAs, infarction, and hemorrhage, and the majority of patients had preserved or improved functional status.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2009.3.jns08837","type":"journal-article","created":{"date-parts":[[2009,4,17]],"date-time":"2009-04-17T13:49:32Z","timestamp":1239976172000},"page":"936-942","source":"Crossref","is-referenced-by-count":100,"title":["Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease"],"prefix":"10.3171","volume":"111","author":[{"given":"Robert M.","family":"Starke","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo J.","family":"Komotar","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary L.","family":"Hickman","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yehuda E.","family":"Paz","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela G.","family":"Pugliese","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc L.","family":"Otten","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew C.","family":"Garrett","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell S. V.","family":"Elkind","sequence":"additional","affiliation":[{"name":"Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randolph S.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne R.","family":"Festa","sequence":"additional","affiliation":[{"name":"Neuropsychology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip M.","family":"Meyers","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Neuroradiology, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Sander","family":"Connolly","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-08837","series-title":"Science","first-page":"964","article-title":"Isolation of putative progenitor endothelial cells for angiogenesis","volume":"275","author":"Asahara","year":"1997"},{"key":"b2-08837","series-title":"Stroke","first-page":"1347","article-title":"Clinical features of moyamoya disease in the United States","volume":"29","author":"Chiu","year":"1998"},{"key":"b3-08837","series-title":"J Neurosurg","first-page":"180","article-title":"Cranial burr hole for revascularization in moyamoya disease","volume":"71","author":"Endo","year":"1989"},{"key":"b4-08837","series-title":"Stroke","first-page":"1490","article-title":"Clinical features and outcome in North American adults with moyamoya phenomenon","volume":"37","author":"Hallemeier","year":"2006"},{"issue":"Suppl 2","key":"b5-08837","series-title":"Clin Neurol Neurosurg","first-page":"S151","article-title":"Moyamoya disease in adults: characteristics of clinical presentation and outcome after encephalo-duro-arterio-synangiosis","volume":"99","author":"Han","year":"1997"},{"key":"b6-08837","series-title":"Stroke","first-page":"2431","article-title":"Determinants of staged endovascular and surgical treatment outcome of brain arteriovenous malformations","volume":"36","author":"Hartmann","year":"2005"},{"key":"b7-08837","series-title":"N Engl J Med","first-page":"593","article-title":"Circulating endothelial progenitor cells, vascular function, and cardiovascular risk","volume":"348","author":"Hill","year":"2003"},{"issue":"Suppl 2","key":"b8-08837","series-title":"Clin Neurol Neurosurg","first-page":"S142","article-title":"Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications","volume":"99","author":"Houkin","year":"1997"},{"key":"b9-08837","series-title":"Stroke","first-page":"2513","article-title":"A clinical comparison of definite moyamoya disease between South Korea and Japan","volume":"28","author":"Ikezaki","year":"1997"},{"key":"b10-08837","series-title":"Stroke","first-page":"1170","article-title":"Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease","volume":"28","author":"Ishikawa","year":"1997"},{"key":"b11-08837","series-title":"Clin Exp Hypertens","first-page":"631","article-title":"Management of patients with symptomatic carotid artery occlusion","volume":"24","author":"Kappelle","year":"2002"},{"key":"b12-08837","series-title":"J Neurosurg","first-page":"84","article-title":"Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease","volume":"77","author":"Karasawa","year":"1992"},{"key":"b13-08837","series-title":"J Neurosurg","article-title":"The role of indirect extracranial-intracranial bypass in the treatment of symptomatic intracranial atheroocclusive disease. Clinical article","author":"Komotar"},{"key":"b14-08837","series-title":"Surg Neurol","first-page":"353","article-title":"The Moyamoya syndrome and the neurosurgeon","volume":"4","author":"Krayenbuhl","year":"1975"},{"key":"b15-08837","series-title":"Stroke","first-page":"42","article-title":"Prevalence and clinicoepidemiological features of moyamoya disease in Japan: findings from a nationwide epidemiological survey","volume":"39","author":"Kuriyama","year":"2008"},{"key":"b16-08837","series-title":"AJNR Am J Neuroradiol","first-page":"741","article-title":"Postoperative evaluation of moyamoya disease with perfusion-weighted MR imaging: initial experience","volume":"24","author":"Lee","year":"2003"},{"key":"b17-08837","series-title":"J Clin Neurosci","first-page":"42","article-title":"Prospective study of neuropsychological and psychosocial outcome following surgical excision of intracerebral arteriovenous malformations","volume":"10","author":"Marshall","year":"2003"},{"key":"b18-08837","series-title":"Neurosurgery","first-page":"401","article-title":"Surgical treatment of moyamoya disease in pediatric patients\u2014 comparison between the results of indirect and direct revascularization procedures","volume":"31","author":"Matsushima","year":"1992"},{"key":"b19-08837","series-title":"Neurol Med Chir (Tokyo)","first-page":"708","article-title":"Effects of encephalo-duro-arterio-synangiosis on childhood moyamoya patients\u2014swift disappearance of ischemic attacks and maintenance of mental capacity","volume":"31","author":"Matsushima","year":"1991"},{"key":"b20-08837","series-title":"Surg Neurol","first-page":"343","article-title":"Perioperative complications of encephalo-duro-arterio-synangiosis: prevention and treatment","volume":"36","author":"Matsushima","year":"1991"},{"key":"b21-08837","series-title":"No Shinkei Geka","first-page":"1559","article-title":"[Effects of indirect EC\/IC bypass operations on adult moyamoya patients.]","volume":"14","author":"Matsushima","year":"1986"},{"key":"b22-08837","series-title":"Surg Neurol","first-page":"541","article-title":"Indirect revascularization for moyamoya disease: is there a beneficial effect for adult patients?","volume":"45","author":"Mizoi","year":"1996"},{"issue":"Suppl 3","key":"b23-08837","series-title":"Cerebrovasc Dis","first-page":"45","article-title":"Thomas Willis Lecture. Acute clinical trials: an expression of concern","volume":"9","author":"Mohr","year":"1999"},{"issue":"Suppl 2","key":"b24-08837","series-title":"Clin Neurol Neurosurg","first-page":"S156","article-title":"Long-term results of surgically treated moyamoya disease","volume":"99","author":"Nakashima","year":"1997"},{"key":"b25-08837","series-title":"Neurol Med Chir (Tokyo)","first-page":"221","article-title":"[Moyamoya disease (author's transl).]","volume":"19","author":"Nishimoto","year":"1979"},{"key":"b26-08837","series-title":"Scott Med J","first-page":"254","article-title":"Cerebral vascular accidents in patients over the age of 60. III. Diagnosis and treatment","volume":"2","author":"Rankin","year":"1957"},{"key":"b27-08837","series-title":"No Shinkei Geka","first-page":"705","article-title":"[Hemorrhagic type of moyamoya disease.]","volume":"19","author":"Saeki","year":"1991"},{"key":"b28-08837","series-title":"Arch Neurol","first-page":"288","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki","year":"1969"},{"key":"b29-08837","series-title":"Mayo Clin Proc","first-page":"749","article-title":"Moyamoya disease: the disorder and surgical treatment","volume":"69","author":"Ueki","year":"1994"},{"issue":"4","key":"b30-08837","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Optimal surgical treatment for moyamoya disease in adults: direct versus indirect bypass","volume":"26","author":"Starke","year":"2009"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/111\/5\/article-p936.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/111\/5\/article-p936.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/111\/5\/article-p936.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T10:28:17Z","timestamp":1679912897000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/111\/5\/article-p936.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2009,11]]},"references-count":30,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2009.3.jns08837","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,11]]}}}