Moyamoya vasculopathy (MMV) is a rare cerebrovascular disease that is characterized by bilateral progressive steno-occlusion of basal cerebral arteries, with the emergence of coexisting abnormal net-like vessels. In moyamoya disease, MMV is the single manifestation, whereas in moyamoya syndrome or quasi-moyamoya, MMV is associated with a potentially underlying disease such as a genetic disorder or other coexisting pathology. Although MMV is most frequent in Asian countries, it is ranked among the most frequent causes of stroke in children and adults across the world. The incidence of MMV is on the rise due to increasing awareness of the disease.
The relevance of surgical treatment of moyamoya disease by way of bypass revascularization is undisputed, which is in contrast to the surgical treatment of atherosclerotic carotid artery occlusion. The main aims of revascularization are to restore the blood supply to stabilize cerebrovascular hemodynamics and to regress the fragile moyamoya vessels in order to prevent bleeding. A successful improvement or normalization of cerebral hemodynamics will then result in secondary stroke prevention and improved neurological or neurocognitive outcome. Consequently, bypass surgery for MMV has become an integral part of the clinical practice of many microvascular neurosurgeons around the world.
While the role of bypass surgery is well accepted, a versatile range of surgical techniques and strategies exists in the field, which makes it difficult to determine and appreciate the subtle nuances of the varied surgical strategies.
Therefore, it seemed logical to create an instructive manual for neurosurgeons with a step-by-step guide to the surgical techniques. The focus of this book is on introducing neurosurgeons (and other physicians involved in the treatment of these patients) to the different surgical techniques, to the inherent strengths and weaknesses of each technique, and to the surgical considerations that need to be kept in mind. We are grateful to the contributing authors, who are all authorities in their respective fields, for sharing their unique knowledge and expertise with the readers. The descriptions provided by each of them are characterized by an expert assessment of the distinct surgical techniques and their variations, as well as by a standardized illustration of the surgical steps. This book will thus serve as the key manual for everyone interested in the treatment of these complexities and for those who find it a rewarding experience to treat these patients.
Peter Vajkoczy, MD
Sepideh Amin-Hanjani, MD
Department of Neurosurgery University of Illinois at Chicago
Chicago, Illinois, USA
Gregory D. Arnone, MD
Department of Neurosurgery
Penn State College of Medicine
Hershey, Pennsylvania, USA
Thomas Blauwblomme, MD
Department of Pediatric Neurosurgery
Hospital Necker
Assistance Publique Hopitaux de Paris (APHP) Universite Rene Descartes, PRES Sorbonne Paris Cite Paris, France
Kees P.J. Braun, MD
Department of Neurology and Neurosurgery UMC Utrecht Brain Center
Utrecht, The Netherlands
Fady T. Charbel, MD, FAANS, FACS
Professor and Head, Department of Neurosurgery Richard L. and Gertrude W. Fruin Professor
University of Illinois at Chicago
Chicago, Illinois, USA
Marcus Czabanka, MD
Professor and Vice Chairman
Department of Neurosurgery
Charite Universitatsmedizin Berlin
Berlin, Germany
Giuseppe Esposito, MD, PhD
Neurosurgeon, Senior Physician
Department of Neurosurgery
Clinical Neurocenter
University Hospital Zurich
University of Zurich
Zurich, Switzerland
Jorn Fierstra, MD, PhD
Department of Neurosurgery
Clinical Neurocenter
University Hospital Zurich
University of Zurich
Zurich, Switzerland
Bettina Fohre, MD
Consultant of Anesthesiology
Department of Anesthesiology and Operative
Intensive Care Medicine (CCM/CVK)
Charite Universitatsmedizin Berlin
Berlin, Germany
Menno R. Germans, MD
Neurosurgeon
Department of Neurosurgery
University Hospital Zurich
Zurich, Switzerland
Nestor R. Gonzalez, MD, MSCR, FAANS, FAHA
Professor of Neurosurgery
Director, Neurovascular Laboratory
Neuroendovascular Fellowship Program Director
Cedars-Sinai Medical Center
Advanced Health Sciences Pavilion (AHSP)
Los Angeles, California, USA
Ziad A. Hage, MD, FAANS
Novant Health Presbyterian Medical Center
Adjunct Associate Professor
Campbell University
School of Osteopathic Medicine
Charlotte, North Carolina, USA
Nils Hecht, MD
Department of Neurosurgery
Charite Universitatsmedizin Berlin
Berlin, Germany
Satoshi Hori, MD, PhD
Department of Neurosurgery
Graduate School of Medicine and Pharmacological
Science
University of Toyama
Toyama, Japan
Kiyohiro Houkin, MD
Department of Neurosurgery
Faculty of Medicine
Hokkaido University
Sapporo, Japan
Hao Jiang, MD
Department of Neurosurgery
The First Affiliated Hospital
Zhejiang University School of Medicine
Hangzhou, China
Jeremiah N. Johnson, MD, FAANS
Assistant Professor
Department of Neurosurgery Baylor College of Medicine Houston, Texas USA
Akitsugu Kawashima, MD, PhD
Chief, Department of Neurosurgery
Tokyo Women’s Medical University Yachiyo Medical Center
Chiba, Japan
Ken Kazumata, MD, PhD
Department of Neurosurgery
Hokkaido University Graduate School of Medicine
Sapporo, Japan
Catharina J.M. Klijn, MD
Department of Neurology and Neurosurgery UMC Utrecht Brain Center
Utrecht, The Netherlands
Department of Neurology
Donders Institute for Brain, Cognition and Behavior Center for Neuroscience
Radboud University Medical Center
Nijmegen, The Netherlands
Susanne Konig, MD, DESA
Consultant of Anesthesiology
Department of Anesthesiology and Operative
Intensive Care Medicine (CCM/CVK)
Charite Universitatsmedizin Berlin
Berlin, Germany
Annick Kronenburg, MD
Department of Neurology and Neurosurgery UMC Utrecht Brain Center
Utrecht, The Netherlands
Satoshi Kuroda, MD, PhD
Professor and Chairman
Department of Neurosurgery
Graduate School of Medicine and Pharmaceutical
Science
University of Toyama
Toyama, Japan
David J. Langer, MD
Department of Neurosurgery
Hofstra North Shore-Long Island Jewish School of Medicine
Lenox Hill Hospital
New York, New York, USA
Philippe Meyer, MD
Department of Pediatric Anesthesiology
Hospital Necker
Assistance Publique Hopitaux de Paris (APHP)
Paris, France
Alessandro Narducci, MD
Division of Neurosurgery
San Giovanni Bosco Hospital
Turin, Italy
Erez Nossek, MD
Division of Neurosurgery
Maimonides Medical Center
Brooklyn, New York, USA
Luca Regli, MD
Professor and Chairman
Department of Neurosurgery
Clinical Neurocenter
University Hospital Zurich
University of Zurich
Zurich, Switzerland
Christian Sainte-Rose, MD
Department of Pediatric Neurosurgery
Hospital Necker
Assistance Publique Hopitaux de Paris (APHP)
Universite Rene Descartes, PRES Sorbonne Paris Cite Paris, France
Michael Schiraldi, MD, PhD
Neurosurgeon
Institute of Clinical Orthopedics & Neurosciences
Desert Regional Medical Center
Palm Springs, California, USA
Edward Smith, MD
Department of Neurosurgery
Boston Children’s Hospital
Harvard Medical School
Boston, Massachusetts, USA
Robert F. Spetzler, MD
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA
Gary K. Steinberg, MD, PhD
Bernard and Ronni Lacroute-William Randolph Hearst Professor of Neurosurgery and the Neurosciences
Chair, Department of Neurosurgery
Stanford University School of Medicine
Stanford, California, USA
Mario Teo, MBChB(Hons), FRCS(SN)
Consultant Neurosurgeon
Department of Neurosurgery
Bristol Institute of Clinical Neuroscience
North Bristol University Hospital
Bristol, UK
Peter Vajkoczy, MD
Professor
Chairman, Department of Neurosurgery and Pediatric Neurosurgery
Charite Universitatsmedizin Berlin
Berlin, Germany
John E. Wanebo, MD
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA
Bin Xu, MD, PhD
Department of Neurosurgery, Huashan Hospital Shanghai Medical School, Fudan University Shanghai, China
Albert van der Zwan, MD
Department of Neurology and Neurosurgery
UMC Utrecht Brain Center
Utrecht, The Netherlands