Surgical Treatment Moyamoya Disease

2021 ◽  
Author(s):  
Vicente Vanaclocha ◽  
Nieves Saiz-Sapena ◽  
Leyre Vanaclocha
Keyword(s):  
Surgical Treatment ◽  
Cerebrovascular Disease ◽  
Moyamoya Disease ◽  
East Asian ◽  
Point Of View ◽  
Age Group ◽  
Combined Procedures ◽  
Asymptomatic Patients ◽  
Paediatric Age ◽  
Diagnostic Capabilities

Moyamoya disease is a rare cerebrovascular disease most prevalent in East Asian Countries. Thanks to the new diagnostic capabilities, the number of cases discovered has been rising steadily in the latest years, including many asymptomatic patients. But asymptomatic from the clinical point of view does not necessarily mean that there are no subjacent problems and that there will be no disease progression. Indeed, many patients harbour cognitive decline long before they start with clinical or even radiological manifestations. The only effective treatment is surgical revascularization, with all its possibilities: direct, indirect, and combined. While direct techniques are more useful in adult moyamoya patients, children seem to benefit most from indirect techniques. Additionally, indirect or combined procedures can be used as salvage procedures in case of unsatisfactory outcomes. Thus, many surgeons posit that surgical treatment should be considered in moyamoya patients, even if asymptomatic, particularly in the paediatric age group.

scholarly journals Endometriosis in urology - an update

2021 ◽  
Vol 28 (1) ◽  
pp. 41-47
Author(s):  
Dan SPINU ◽  
◽  
Dragos Radu MARCU ◽  
Ovidiu BRATU ◽  
Lucian IORGA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Differential Diagnosis ◽  
Urinary Tract ◽  
Surgical Treatment ◽  
Robotic Surgery ◽  
Point Of View ◽  
Relative Safety ◽  
Asymptomatic Patients ◽  
Gynecological Diseases

Introduction: Endometriosis represents the aberrant implantation of endometrial tissue, respectively outside the uterus. It is one of the gynecological diseases with a great impact on the patient’s quality of life and especially on the fertility aspects. Due to the aberrant implantation, this disease can theoretically affect any organ in the abdominal and retroperitoneal cavity. Thus, cases involving the organs of the urinary tract are not a surprise. Material and methods: The present paper focuses on the urological impairment of endometriosis, etiology according to various hypotheses and an update of existing treatment methods. The possible proposals of therapeutic guides found in the literature are also taken into account.Results: The urological condition of this disease seems to increase in frequency in recent years. If in the case of asymptomatic patients an expectant attitude can be approached in relative safety, the local invasive nature of the disease, which can lead to the loss of the function of the various organs of the urinary tract, must not be omitted. In the case of symptomatic patients, the treatment is either hormonal or surgical, lately there is a tendency to combine the two types of treatment. Being a condition with relatively rare urological involvement, the differential diagnosis often omits endometriosis. There are currently several plausible guide proposals, but it takes time and richer casuistry to be able to standardize them. From the point of view of surgical treatment, there is a tendency to introduce robotic surgery in the therapeutic arsenal of this disease, both in the case of classical endometriosis and in the case of urological involvement.

scholarly journals Diverse clinical presentations of Moyamoya disease: a case series

2021 ◽  
Author(s):  
Hendrick Henrique Fernandes Gramasco ◽  
Mateus Felipe dos Santos ◽  
Yasmim Nadime José Frigo ◽  
Guilherme Drumond Jardini Anastácio ◽  
Stella de Angelis Trivellato ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Moyamoya Disease ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Case Series ◽  
Point Of View ◽  
Cerebrovascular Events ◽  
Clinical Presentations ◽  
Proximal Occlusion

Context: Moyamoya disease or chronic occlusive cerebrovascular disease is characterized by proximal occlusion of the internal carotid artery and its branches bilaterally, generating an angiographic “smoke” pattern (moyamoya, from Japanese “something hazy”) and by diverse ischemic manifestations. Case report: The sample consists of three female patients, aged between 13 and 46 years, followed in our service due to the diagnosis of Moyamoya Disease. Among the clinical manifestations presented, ischemic cerebrovascular events with neurological deficit predominated, and one of the patients presented two episodes compatible with stroke and one episode compatible with transient ischemic accident. The youngest patient presented with a choreic picture initially interpreted as Sydenham’s chorea. Although the gold standard for the diagnosis of chronic occlusive cerebrovascular disease is cerebral arterial angiography, it was possible to observe a pattern compatible with the disease in other modalities of examination, such as cerebral arterial angiotomography and cerebral arterial angioresonance. From the therapeutic point of view, one of the patients underwent surgical intervention (encephaloduromyosinangiosis), with improvement of symptoms after treatment. Conclusions: In this paper, we emphasize the importance of complementary imaging tests in the evaluation of patients with cerebrovascular syndromes and the diversity of clinical presentation of Moyamoya disease.

scholarly journals Valgus-impacted fracture of neck of femur in a 12-year-old child

2021 ◽  
Vol 14 (3) ◽  
pp. e240707
Author(s):  
Sujayendra Davanagere Murali ◽  
Nikhil Hegde ◽  
Hitesh Shah
Keyword(s):  
Surgical Treatment ◽  
Adult Population ◽  
Fracture Pattern ◽  
Age Group ◽  
Neck Of Femur ◽  
Impacted Fracture ◽  
Paediatric Age ◽  
Type Of Fracture

Though uncommon, fracture of neck of femur in children is a devastating injury due to the complications it may cause. Treatment depends on the age of the child, the displacement of the fracture and the type of fracture based on Delbet classification. Surgical treatment is indicated in displaced fractures. We report a case of an impacted fracture of neck of femur in a 12-year-old girl. The girl was managed non-operatively. The fracture united uneventfully. An impacted fracture of neck of femur is common in the adult population. To the best of our knowledge, this fracture pattern has not been reported in the paediatric age group.

Clinico-pathological study of acute pain abdomen in paediatric age group

2019 ◽  
Vol 13 (2) ◽  
pp. 108-111
Author(s):  
Vidya M Saravagol ◽  
◽  
Deepak Shanbhag ◽  
Ashraf Ahamed ◽  
Kartik Sadananda ◽  
...  
Keyword(s):  
Acute Pain ◽  
Age Group ◽  
Pathological Study ◽  
Pain Abdomen ◽  
Paediatric Age

Mit Initialfemeln zum Plenterwald (Essay) | The creation of selection forest using initial femel cut (essay)

2009 ◽  
Vol 160 (6) ◽  
pp. 137-143
Author(s):  
Rudi Kynast
Keyword(s):  
Mixed Forest ◽  
Point Of View ◽  
Age Group ◽  
Black Forest ◽  
Crown Height ◽  
Short Intervals ◽  
Total Growth ◽  
Cost Calculations ◽  
Selection Forest ◽  
Individual Trees

Although selection forests have clear advantages over age-group forests in view of their total growth performance, their net product and their stability, not to mention the sustainability of their beneficial effect, the proportion of this type of forest is insignificantly small in Germany and also in mixed forest in the mountains. It is therefore all the more surprising that scarcely any discernable efforts have been made to increase the proportion of selection forests. For a conversion, an alternative model for the treatment of the stands is adopted, whereby it is no longer the encouragement of the growth to maturity of individual trees in the stand which is aimed for, but rather the transformation of the whole stand to a selection forest using available stand elements and elements created by an early initiation of regeneration. Based on his experience in the forestry district of Kirchzarten in the Black Forest, Germany, the author describes the procedure for a successful conversion. This is to be started as soon as possible, that is to say when the crown height of the trees is about 18 metres and with corresponding usable dimensions, using small group shelter-wood cuts, a so-called initial femel cut. To get the conversion started it is advisable to remove whole groups of predominantly badly situated and overgrown trees. The stand will be additionally structured later through further interventions at short intervals. In the process, here and there really well situated trees will actually be left to stand solitar y, in other places w hol e self-cont aine d groups will b e created and else where valuabl e mixed s tand elements will be selected for permanent preservation, this in order to create a situation in which there are about 35 overstorey trees per hectare. On the basis of his own cost calculations, the author comes to the conclusion that the conversion is, from a financial point of view, superior compared with the age-group forest in that it brings higher proceeds more quickly and more often.

scholarly journals Hyperhomocysteinemia in a Patient with Moyamoya Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Durga Shankar Meena ◽  
Gopal Krishana Bohra ◽  
Mahadev Meena ◽  
Bharat Kumar Maheshwari
Keyword(s):  
Cerebrovascular Disease ◽  
Moyamoya Disease ◽  
Cerebral Angiography ◽  
Rare Case ◽  
Homocysteine Level ◽  
Case Reports ◽  
Circle Of Willis

Moyamoya disease is a chronic progressive cerebrovascular disease characterized by bilateral occlusion or stenosis of arteries around circle of Willis. We report a case of 18-year-old female presented with recurrent episodes of headache and vertigo. On cerebral angiography, the patient was diagnosed to have moyamoya disease. On further evaluation, thrombophilia profile showed increased homocysteine level. The patient was treated conservatively with cobalamin and aspirin and advised for revascularization. According to the literature, there are few case reports of moyamoya disease with thrombotic disorders. Hence, we are reporting this interesting and rare case.

Modified Encephaloduroarteriosynangiosis as a Surgical Treatment of Childhood Moyamoya Disease: Report of Five Cases

1991 ◽  
Vol 6 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Cynthia M. Rooney ◽  
Edward M. Kaye ◽  
R. Michael Scott ◽  
Richard P. Klucznik ◽  
N. Paul Rosman
Keyword(s):  
Surgical Treatment ◽  
Moyamoya Disease

scholarly journals Surgical Treatment of Childhood Moyamoya Disease

1995 ◽  
Vol 35 (4) ◽  
pp. 231-237 ◽  
Author(s):  
Akihiro TAKAHASHI ◽  
Hiroyasu KAMIYAMA ◽  
Kiyohiro HOUKIN ◽  
Hiroshi ABE
Keyword(s):  
Surgical Treatment ◽  
Moyamoya Disease

Synergistic Interactions Between Direct and Indirect Bypasses in Combined Procedures: The Significance of Indirect Bypasses in Moyamoya Disease

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Haruto Uchino ◽  
Jae-Hoon Kim ◽  
Noriyuki Fujima ◽  
Ken Kazumata ◽  
Masaki Ito ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Disease Onset ◽  
Chronic Phase ◽  
Temporal Artery ◽  
Middle Meningeal Artery ◽  
Hemodynamic Parameters ◽  
Combined Procedures ◽  
Multiple Variables ◽  
Meningeal Artery

Abstract BACKGROUND: Whether additional indirect bypasses effectively contribute to revascularization in combined procedures remains unclear in patients with moyamoya disease. OBJECTIVE: To evaluate the longitudinal changes associated with combined procedures while following up pediatric and adult patients long term and to assess whether any other clinical factors or hemodynamic parameters affected these changes to determine an optimal surgical strategy. METHODS: We studied 58 hemispheres in 43 adults and 39 hemispheres in 26 children who underwent combined revascularization for moyamoya disease. To evaluate bypass development, we assessed the sizes of the superficial temporal artery and middle meningeal artery using magnetic resonance angiography. Multivariate analysis determined the effects of multiple variables on bypass development. RESULTS: Indirect bypass (middle meningeal artery) development occurred in 95% and 78% of the pediatric and adult hemispheres, respectively. Of these, dual development of direct and indirect bypasses occurred in 54% of the pediatric hemispheres and in 47% of the adult hemispheres. Reciprocal superficial temporal artery regression occurred in 28% of the hemispheres during the transition from the postoperative acute phase to the chronic phase during indirect bypass development. Good indirect bypass development was associated with adult hemispheres at Suzuki stage 4 or greater (odds ratio, 7.4; 95% confidence interval, 1.4-39.4; P = .02). Disease onset type and preoperative hemodynamic parameters were not considered predictors for the development of surgical revascularization. CONCLUSION: Simultaneous direct and indirect bypass development was most frequently observed, regardless of patient age and hemodynamic status. Applying indirect bypass as an adjunct to direct bypass could maximize revascularization in adults and children.

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