Moyamoya syndrome in patients with hyperthyroidism: clinical features and surgical treatment

Objective To preliminarily investigate the clinical features and efficacy of surgical treatment of moyamoya syndrome in patients with hyperthyroidism. Methods From December 2002 to April 2013, 41 patients with moyamoya syndrome based on the disease of hyperthyroidism admitted to the Department of Neurosurgery, the 307th Hospital of PLA were analyzed retrospectively. The clinical data were collected, including sex, age of onset, initial symptoms, progress symptoms, imaging features, Suzuki staging, and surgical efficacy, and they were compared with the clinical data of the patients with moyamoya disease treated at the same time. Results The ratio of male to female was about 1∶4 in moyamoya syndrome patients with hyperthyroidism. The peak age of onset was 25 to 34 years old. Compared with the patients with moyamoya disease at the same period, the proportion of patients with cerebral infarction as initial symptom was higher in the moyamoya syndrome group (39.0% vs.24.2%; χ2=4.796, P=0.029), more patients had symptomatic progression (46.3% vs. 25.4%; χ2=9.207, P=0.002), and the proportion of of patients with cerebral hemorrhage as initial symptom was lower (2.4% vs. 14.6%; χ2=4.829, P=0.028). Thirty-seven patients who received encephalo-duro-arterio-synangiosis (EDAS) were followed up for 43±19 months. The results showed that the clinical symptoms of 31 patients had different degrees of improvement. Conclusions Moyamoya syndrome of hyperthyroidism is more common in women. The risk of cerebral infarction is higher and more prone to have disease progression. The efficacy of EDAS is better for controlling the progression of moyamoya syndrome in patients with hyperthyroidism. Key words: Moyamoya Disease; Hyperthyroidism; Cerebral Revascularization