Mayo Clinic doctors trained in brain conditions (neurologists) and brain surgery (neurosurgeons) work together to treat people with moyamoya disease.
Doctors will evaluate your condition and determine the most appropriate treatment for your condition. The goal of treatment is to reduce your symptoms, improve your blood flow and lower your risk of serious complications such as strokes, bleeding in your brain (intracerebral hemorrhages) or death.
Your treatment may include:
After you're diagnosed with moyamoya disease, if you have mild or no symptoms at first, then your doctor may recommend you take aspirin to prevent strokes. Consider giving your child over-the-counter pain medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to ease symptoms.
If your symptoms become worse or if tests show evidence of low blood flow, your doctor may recommend revascularization surgery.
In revascularization surgery, surgeons bypass blocked arteries to help restore blood flow to your brain. Mayo Clinic doctors may use direct or indirect revascularization procedures, or a combination of both.
April 26, 2014
Direct revascularization procedures. In direct revascularization surgery, surgeons stitch (suture) the scalp artery directly to a brain artery (superficial temporal artery to middle cerebral artery bypass surgery) to increase blood flow to your brain immediately.
Direct bypass surgery may be difficult to perform in children, due to the size of the blood vessels to be attached.
Direct revascularization surgery has a risk of complications such as stroke.
Indirect revascularization procedures. Indirect revascularization includes several options. In indirect revascularization, the goal is to increase blood flow to your brain gradually over time. Indirect revascularization may have fewer complications and take less time to conduct than does direct revascularization.
In encephaloduroarteriosynangiosis (EDAS), your surgeon separates (dissects) a scalp artery over several inches.
Your surgeon makes a small temporary opening in your skull directly beneath the artery and attaches (sutures) the intact scalp artery to the surface of your brain, which allows blood vessels from the artery to grow into your brain over time. The surgeon then replaces the bone and closes the opening in your skull.
In encephalomyosynangiosis (EMS), your surgeon separates (dissects) a muscle in the temple region of your forehead and places it onto the surface of your brain through an opening in your skull to help restore blood flow.
Your surgeon may perform EMS with EDAS. In this procedure, your surgeon separates (dissects) a muscle in the temple region of your forehead and places it onto the surface of your brain, after attaching the scalp artery to the surface of your brain. The muscle helps to hold the artery in place as blood vessels grow into your brain over time.
Your surgeon may remove a portion of a fatty layer of tissue from the abdominal area, place it onto the surface of your brain, and attach the scalp artery to the blood vessel of the fatty layer (omental transplant). This procedure may restore blood flow to your brain.
Your surgeon may make multiple holes (burr holes) in your skull to allow new blood vessels to grow, either as a separate procedure or in combination with other procedures.
Your doctor may use other combinations of direct and indirect revascularization procedures depending on your needs.
- NINDS moyamoya disease information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/moyamoya/moyamoya.htm. Accessed Oct. 28, 2013.
- Suwanwela NC. Moyamoya disease: Etiology, clinical features, and diagnosis. http://www.uptodate.com/home. Accessed Oct. 28, 2013.
- Weinberg DG, et al. Moyamoya disease: A review of histopathology, biochemistry, and genetics. Neurosurgical Focus. 2011;30:E20.
- Riggin EA. Decision Support System. Mayo Clinic, Rochester, Minn. Oct. 8, 2013.
- Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Oct. 28, 2013.
- Suwanwela NC. Moyamoya disease: Treatment and prognosis. http://www.uptodate.com/home. Accessed Oct. 28, 2013.
- Baaj AA, et al. Surgical management of moyamoya disease: A review. Neurosurgical focus. 2009;26:E7.
- Pandey P, et al. Neurosurgical advances in the treatment of moyamoya disease. Stroke. 2011;42:3304.
- Brown RD (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 6, 2013.
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