Thus far, the evaluation of surgical outcome after revascularization for MMD depends on angiography using the Matsushima grading system. However, only some patients follow this stepwise progression, and the staging is not correlated with the clinical symptoms. Suzuki and Takaku 8 proposed 6 stages of angiographic evolution in MMD. 5 ⇓– 7Įvaluation of MMD severity has largely depended on conventional angiography. 2 ⇓– 4 The effectiveness of indirect revascularization in adult patients with MMD, however, has been supported by clinical and angiographic evaluations. Although the clinical response to surgical treatment appears to be favorable in most cases, there is considerable debate regarding the advantages and disadvantages of direct and indirect revascularizations, particularly for adult patients. 1 Surgical revascularization is the only effective therapy for patients with MMD to reduce their risk of subsequent strokes. The major clinical presentation is ischemic stroke in both children and adults. MMD has 2 age peaks: at approximately 10 years and at 30–40 years. Moyamoya disease (MMD) is a progressive occlusive disease of the supraclinoid segment of the ICA associated with collateral vessel formation at the base of the brain. ABBREVIATIONS: EDAS encephaloduroarteriosynangiosis EPS encephalopericraniosynangiosis MMD Moyamoya disease MRP MR perfusion
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