Clinical features, treatment, and outcomes of moyamoya disease in the elderly

Objective To preliminarily explore the clinical features, treatment, and outcomes of moyamoya disease in the elderly. Methods The clinical data of the elderly patients with moyamoya disease (aged >60 years) admitted to the Department of Neurosurgery, the 307th Hospital of PLA from May 2007 to July 2016 were collected retrospectively. Their clinical features, imaging features, and surgical outcomes were analyzed. Results A total of 68 patients were enrolled, including 35 females (51.47%) and 33 males (48.53%). The ratio of male to female was 1∶1.06. The age at the time of diagnosis of moyamoya disease was 62.82±3.08 years. Fifty-two patients (76.5%) had vascular risk factors. The most common clinical manifestation was cerebral ischemia (n=61, 89.7%). Thirty of them (44.1%) presented as transient ischemic attack. The Suzuki staging of most patients was 4-6 (71.6%), 12 patients (17.6%) complicated with posterior cerebral artery stenosis or occlusion. Thirty-one patients were treated with encephalo-duro-arterio-synangiosis (EDAS). Among them, 17 patients underwent bilateral surgery and 14 underwent unilateral surgery. The incidence of perioperative infarction or hemorrhage was 5.6% (2 patients developed cerebral infarction and 1 patient developed cerebral hemorrhage); 37 patients received conservative treatment. During the follow-up period, 5 patients developed cerebral infarction (1 in the surgical treatment group and 4 in the conservative treatment group); there was no significant difference between the 2 groups. There were no significant differences in age, sex, vascular risk factor, clinical symptoms, and preoperative modified Rankin Scale (mRS) scores between the 2 groups. Cerebral angiography was performed 6-9 months after operation in the surgical treatment group. A total of 24 cerebral hemispheres were evaluated by Matsushima typing, of which 17 (70.8%) were excellent. During the follow-up period, the proportion of patients with clinical outcome excellent (the mRS score was 0) (Z=-5.268, P<0.001) and clinical improvement (the mRS score was improved ≥1 compared to the baseline) (Z=-3.780, P<0.001) were significantly higher than the conservative treatment group. Conclusions The clinical symptoms of old patients with moyamoya disease were mainly cerebral ischemia. Most of them had vascular risk factors, and the imaging manifestations showed higher Suzuki staging. The perioperative risk of EDAS in the old patients with moyamoya disease was lower. It might be an effective method to prevent clinical symptoms progress and improve the outcomes. Key words: Moyamoya Disease; Cerebral Revascularization; Treatment Outcome; Old People