{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T01:39:09Z","timestamp":1789954749932,"version":"4.0.1"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,12]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic> The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic> A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.<\/jats:p><jats:p content-type=\"fine-print\">Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%\/person\/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic> The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.<\/jats:p>","DOI":"10.3171\/jns.2000.93.6.0976","type":"journal-article","created":{"date-parts":[[2009,5,13]],"date-time":"2009-05-13T17:27:02Z","timestamp":1242235622000},"page":"976-980","source":"Crossref","is-referenced-by-count":177,"title":["Long-term natural history of hemorrhagic type moyamoya disease in 42 patients"],"prefix":"10.3171","volume":"93","author":[{"given":"Eiichi","family":"Kobayashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naokatsu","family":"Saeki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromichi","family":"Oishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Hirai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Yamaura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/0090-3019(93)90215-M","article-title":"Cerebrovascular bypass surgery for the treatment of moyamoya disease: unsatisfactory outcome in the patients presenting with intracranial hemorrhage.","volume":"40","author":"Aoki","year":"1993"},{"key":"b2","series-title":"Neurol Med Chir","doi-asserted-by":"publisher","first-page":"860","DOI":"10.2176\/nmc.36.860","article-title":"Intracranial aneurysms associated with moyamoya disease.","volume":"36","author":"Borota","year":"1996"},{"key":"b3","series-title":"Clin Neurol Neurosurg Suppl","first-page":"11","article-title":"Natural history of moyamoya disease: comparison of activity of daily living in surgery and non-surgery groups.","volume":"2","author":"Choi","year":"1997"},{"key":"b4","series-title":"Acta Neurol Scand","first-page":"318","article-title":"Cerebral blood flow findings in moyamoya disease in adults.","volume":"85","author":"Dietrichs","year":"1992"},{"key":"b5","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1007\/BF00300998","article-title":"Clinical and angiographic follow-up of childhood-onset moyamoya disease.","volume":"11","author":"Ezura","year":"1995"},{"key":"b6","series-title":"Clin Neurol Neurosurg Suppl","first-page":"238","article-title":"Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (\u2018Moyamoya\u2019 disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan.","volume":"2","author":"Fukui","year":"1997"},{"key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"328","DOI":"10.3171\/jns.1994.80.2.0328","article-title":"Moyamoya disease with repeated intraventricular hemorrhage due to aneurysm rupture. Report of two cases.","volume":"80","author":"Hamada","year":"1994"},{"key":"b8","series-title":"Clin Neurol Neurosurg Suppl","first-page":"151","article-title":"Moyamoya disease in adults: characteristics of clinical presentation and outcome after encephaloduro-arterio-synangiosis.","volume":"2","author":"Han","year":"1997"},{"key":"b9","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1161\/01.STR.27.8.1342","article-title":"Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage?","volume":"27","author":"Houkin","year":"1996"},{"key":"b10","series-title":"Clin Neurol Neurosurg Suppl","first-page":"183","article-title":"The current status of the treatment for hemorrhagic type moyamoya disease based on a 1995 nationwide survey in Japan.","volume":"2","author":"Ikezaki","year":"1997"},{"key":"b11","series-title":"Neurol Med Chir","doi-asserted-by":"publisher","first-page":"225","DOI":"10.2176\/nmc.38.225","article-title":"Cerebellar hemorrhage associated with moyamoya disease.","volume":"38","author":"Ise","year":"1998"},{"key":"b12","series-title":"Clin Neurol Neurosurg Suppl","first-page":"187","article-title":"Mechanism of intracranial rebleeding in moyamoya disease.","volume":"2","author":"Iwama","year":"1997"},{"key":"b13","series-title":"Lancet","first-page":"480","article-title":"Assessment of outcome after severe brain damage. A practical scale.","volume":"1","author":"Jennett","year":"1975"},{"key":"b14","series-title":"Acta Neurol Scand Suppl","first-page":"85","article-title":"Regression of moyamoya vessels and hemodynamic changes after successful revascularization in childhood moyamoya disease.","volume":"166","author":"Kashiwagi","year":"1996"},{"key":"b15","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"468","DOI":"10.3171\/jns.1996.84.3.0468","article-title":"Multiple burr-hole operation for adult moyamoya disease.","volume":"84","author":"Kawaguchi","year":"1996"},{"key":"b16","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/0090-3019(96)00043-2","article-title":"Treatment of ruptured cerebral aneurysm in moyamoya disease.","volume":"46","author":"Kodama","year":"1996"},{"key":"b17","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1097\/00006123-199804000-00043","article-title":"Cerebral blood flow measurement as an indicator for an indirect revascularization procedure for adult patients with moyamoya disease.","volume":"42","author":"Kohno","year":"1998"},{"key":"b18","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1161\/01.STR.29.3.625","article-title":"Effectiveness of superficial temporal artery-middle cerebral artery anastomosis in adult moyamoya disease. Cerebral hemodynamics and clinical course in ischemic and hemorrhagic varieties.","volume":"29","author":"Okada","year":"1998"},{"key":"b19","series-title":"Clin Neurol Neurosurg Suppl","first-page":"196","article-title":"Hemorrhagic type moyamoya disease.","volume":"2","author":"Saeki","year":"1997"},{"key":"b20","series-title":"No To Shinkei","first-page":"897","article-title":"[Evaluation of a group of disorders showing an abnormal vascular network at the base of the brain with a high incidence among the Japanese. 2. Follow-up studies by cerebral angiography.]","volume":"18","author":"Suzuki","year":"1966"},{"key":"b21","series-title":"No Shinkei Geka","first-page":"23","article-title":"[Long-term follow-up angiography of moyamoya disease\u2014cases followed from childhood to adolescence.]","volume":"14","author":"Takahashi","year":"1986"},{"key":"b22","series-title":"Clin Neurol Neurosurg Suppl","first-page":"118","article-title":"Combined encephalo-arteriosynangiosis and encephalo-myo-synangiosis in the treatment of moyamoya disease.","volume":"2","author":"Tu","year":"1997"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/93\/6\/article-p976.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/93\/6\/article-p976.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/93\/6\/article-p976.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T22:45:57Z","timestamp":1679870757000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/93\/6\/article-p976.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,12]]},"references-count":22,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/jns.2000.93.6.0976","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[2000,12]]}}}