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  • Clinical Presentation, Progresssion, and Treatment Outcomes of Elderly Moyamoya Patients: A Case Series

    Final Number:

    Raghav Gupta Medical Student; Justin M Moore B.Med.Sci (hon), MD, PhD; Nimer Adeeb MD; Christoph Johannes Griessenauer MD; Apar S Patel MD MPH; Michelle Hui Juan Chua BS; Ajith J. Thomas MD; Christopher S. Ogilvy MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Moyamoya disease is a vascular disorder characterized by progressive stenosis of the internal carotid artery. Clinical presentation often results from cerebral ischemia due to reduced perfusion within the cerebral hemispheres or hemorrhaging from the newly-formed collateral arteries. In the North American population, studies have reported a unimodal age distribution that peaks during the third, fourth, or fifth decades. However, the presentation, progression, treatment options, and post-operative clinical outcomes for elderly Moyamoya patients have never been reported.

    Methods: A retrospective analysis of all patients who were diagnosed with Moyamoya disease by the senior authors between 1991 and 2016, was performed. Patients who were 60 years or older at the time of treatment were further evaluated.

    Results: Seventy patients were diagnosed with probable or definite Moyamoya disease during the study period. Eight patients (6 females: 2 males; median age 63.5; range 62-71 years) were found to be sixty years or older and were included in the study. All patients had a Modified Rankin Scale (mRS) of either one or two (median 1) pre-operatively. Six patients (75%) underwent surgical treatment on a total on 7 hemispheres. Post-surgery, one patient had an improved mRS score, and four had no changes in their mRS scores. One patient was lost to follow-up. Of note, both patients who did not undergo surgical interventions suffered from intraparenchymal hemorrhages post-diagnosis.

    Conclusions: Moyamoya disease is most commonly seen in young and middle-aged patients. Presentation in the elderly (defined as sixty years and above in this study) is rare, and has never been reported in literature. In this study, both direct and indirect revascularization procedures demonstrated potential benefit in treatment of these patients, with stabilization of progressive symptoms.

    Patient Care: Given that very few studies in the literature examine the course of Moyamoya disease in the elderly, this report attempts to better depict a single institution's experience with treating this condition in patients 60 yrs or older at the time of surgery. We hope that this will serve as a basis from which to better understand how Moyamoya progresses in these patients, and what treatment options enable functional recovery and stabilization of symptoms in these patients.

    Learning Objectives: By the conclusion of this session, participants should be able to (1) Better understand the presentation, progression, treatment options, and post-operative clinical outcomes amongst elderly, Moyamoya patients and (2) Recognize that both indirect (EDAS) and direct bypass surgical procedures enable stabilization of progressive symptomology in these patients.


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