Artikel
Effect of mouth opening on bypass function after combined revascularization for Moyamoya disease
Suche in Medline nach
Autoren
Veröffentlicht: | 28. April 2011 |
---|
Gliederung
Text
Objective: Moyamoya disease represents a rare steno-occlusive disease of the internal carotid artery (ICA) with a reactive and pathological basal network of collateral vessels. It may lead to ischemic stroke or intracerebral hemorrhage. Treatment options are either direct or indirect revascularization procedures or a combination thereof. Specialized centers report adequate revascularization in most patients and low complication rates.
Methods: Between 2005 and 2008, direct extra-intracranial bypass surgery in combination with encephalomyosynangiosis (EMS) was performed in 71 Moyamoya patients at the Mannheim Universitätsmedizin (University Medical Center).
Following one case of reversible neurological deficits associated with mouth opening, we prospectively evaluated the effect of mouth opening on bypass function in this patient and four further consecutive patients by digital subtraction angiography.
Results: Three out of five patients showed alterations in bypass patency upon mouth opening. The obstruction was located at the junction of the bypass and the temporal muscle. Two temporary occlusions and one case of decreased flow were observed. One patient demonstrated a reversible hemiparesis and aphasia.
Conclusions: Bypass function after combined revascularization for Moyamoya disease can be affected by mouth opening. Particular care should be taken to provide enough space for the bypass when traversing the temporal muscle.