Abstract
Background: Moyamoya disease (MMD) is a chronic cerebrovascular disorder, defined as the progressive
stenosis or occlusion of the intracranial vessels. Because of the insecure cerebral
circulation, these patients represent an anaesthetic challenge. Literature is scarce
on the anaesthetic management of MMD, especially from the Indian subcontinent. The
main objective of our study was to evaluate the peri-operative course and outcome
of patients undergoing surgery for MMD. Materials and Methods: We analysed available medical records of all patients who underwent revascularisation
surgeries for MMD over a period of 10 years (January 2002 to June 2012). Various intra-
and post-operative data related to anaesthesia were recorded. The patients for the
analysis were divided into two groups: Group 1, paediatrics (<18 years) and group
2, adults (≥18 years). Data are presented as number (%) or mean ± SD or median (range).
Results: There were 36 patients (12 adults and 24 children). Normotension, normovolaemia,
normo- or mild-hypercapnia and normothermia were maintained in all patients. No patient
developed complications or new neurological deficit in the post-operative period.
All patients were discharged with a full Glasgow coma scale (GCS) and no new neurologic
deficit. Conclusion: Although the incidence of MMD is not high in India, it is an important cause of cerebral
stroke in children and adults. Proper pre-operative evaluation is the most effective
method to achieve good results. Anaesthetic management of MMD should focus on the
maintenance of adequate cerebral blood flow and cerebral perfusion pressure ensuring
adequate cerebral oxygenation to avoid ischaemic complications.
Keywords
Anaesthesia - moyamoya disease - risk factors - surgery
