Surgical Techniques in Moyamoya Vasculopathy Tricks of the Trade PDF download

Moyamoya vasculopathy (MMV) is a rare cerebrovascular disease that is characterized by bilateral progressive steno-occlusion of basal cerebral arteries, with the emergence of coexisting abnormal net-like vessels. In moyamoya disease, MMV is the single manifestation, whereas in moyamoya syndrome or quasi-moyamoya, MMV is associated with a potentially underlying disease such as a genetic disorder or other coexisting pathology. Although MMV is most frequent in Asian countries, it is ranked among the most frequent causes of stroke in children and adults across the world. The incidence of MMV is on the rise due to increasing awareness of the disease. The relevance of surgical treatment of moyamoya disease by way of bypass revascularization is undisputed, which is in contrast to the surgical treatment of atherosclerotic carotid artery occlusion. The main aims of revascularization are to restore the blood supply to stabilize cerebrovascular hemodynamics and to regress the fragile moyamoya vessels in order to prevent bleeding. A successful improvement or normalization of cerebral hemodynamics will then result in secondary stroke prevention and improved neurological or neurocognitive outcome. Consequently, bypass surgery for MMV has become an integral part of the clinical practice of many microvascular neurosurgeons around the world. While the role of bypass surgery is well accepted, a versatile range of surgical techniques and strategies exists in the field, which makes it difficult to determine and appreciate the subtle nuances of the varied surgical strategies. Therefore, it seemed logical to create an instructive manual for neurosurgeons with a step-by-step guide to the surgical techniques. The focus of this book is on introducing neurosurgeons (and other physicians involved in the treatment of these patients) to the different surgical techniques, to the inherent strengths and weaknesses of each technique, and to the surgical considerations that need to be kept in mind. We are grateful to the contributing authors, who are all authorities in their respective fields, for sharing their unique knowledge and expertise with the readers.