Cho / Tominaga Moyamoya Disease Update

1. Auflage 2010
ISBN: 978-4-431-99703-0
Verlag: Springer Japan
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 387 Seiten

Moyamoya disease (MMD) was first reported as a new entity among vascular disorders in 1957. Named for the abnormal vascular networks found around the occluded distal internal carotid artery, it is the most common pediatric cerebrovascular disease in East Asia. In recent years large amounts of data on MMD have been collected and important investigations have been carried out in Japan and Korea, even as the pathophysiology of the disease remains to be discovered. This monograph covers a diversity of topics and presents a systematic compilation of the data and current status of MMD in clinical practice and basic research. With contributions by more than 70 authors, the book includes sections on genetics, computational analysis of hemodynamic shear stress, new imaging techniques, and endovascular treatment of MMD, along with practical applications and future directions for gene and stem cell therapies. For neurosurgeons as well as neurologists and pediatricians, this volume will help lead to more efficient and informed management of MMD.

Autoren/Hrsg.

Cho, Byung-Kyu

Tominaga, Teiji

Inhaltsverzeichnis

1;Foreword;5
2;Preface;6
3;Contents;7
4;Contributors;12
5;Part I: Introduction;18
5.1;Chapter 1;19
5.1.1;Overview;19
5.1.1.1;Introduction;19
5.1.1.2;Definition and Diagnostic Criteria;19
5.1.1.3;Diagnosis;23
5.1.1.4;History;24
5.1.1.5;Why “Moyamoya”;25
5.1.1.6;Evolution of Research and Lessons from Moyamoya Disease;26
5.1.1.7;References;27
5.2;Chapter 2;28
5.2.1;Pathology of Moyamoya Disease;28
5.2.1.1;Introduction: Pathology of Moyamoya Disease;28
5.2.1.2;Histological Findings in Moyamoya Disease;29
5.2.1.3;Leptomeningeal Vessels;29
5.2.1.4;Vessels with Encephalo-myo-synangiosis;29
5.2.1.5;Perforators;30
5.2.1.6;Hemorrhage from Perforators;30
5.2.1.7;Molecular Analysis with Intracranial Vessels;31
5.2.1.8;Microbleeds in Moyamoya Disease;31
5.2.1.9;Epidemiology;32
5.2.1.10;Comparison with Moyamoya Syndrome;33
5.2.1.11;von Recklinghausen Disease;33
5.2.1.12;Irradiation;33
5.2.1.13;Down Syndrome;34
5.2.1.14;Postinfection;34
5.2.1.15;Endothelial Progenitor Cells in MMD;34
5.2.1.16;Genetic Analysis;35
5.2.1.17;Summary and Conclusion;35
5.2.1.18;References;35
5.3;Chapter 3;39
5.3.1;Unilateral Moyamoya Disease;39
5.3.1.1;Introduction;39
5.3.1.2;Clinical Features of Unilateral Moyamoya Disease;39
5.3.1.3;Progression of Unaffected Hemisphere;40
5.3.1.4;Management Plans;40
5.3.1.5;References;41
6;Part II: Epidemiology;42
6.1;Chapter 4;43
6.1.1;Epidemiology of Moyamoya Disease;43
6.1.1.1;Introduction;43
6.1.1.2;Prevalence and Incidence (Especially in Japan);43
6.1.1.3;Gender Differences;44
6.1.1.4;Familial Occurrence;44
6.1.1.5;Age at Onset;45
6.1.1.6;Types of Clinical Findings;45
6.1.1.7;World Distribution of Moyamoya Disease;46
6.1.1.8;Conclusion;47
6.1.1.9;References;47
6.2;Chapter 5;49
6.2.1;Familial Moyamoya Disease;49
6.2.1.1;Introduction;49
6.2.1.2;Epidemiology;49
6.2.1.3;Mode of Inheritance;50
6.2.1.4;Diagnosis and Clinical Aspect;50
6.2.1.5;Research and Genetics on FMMD;50
6.2.1.6;References;51
7;Part III: Genetics;52
7.1;Chapter 6;53
7.1.1;Overview;53
7.1.1.1;Four Lines of Evidence for Involvement of Genetic Factors in the Etiology of Moyamoya Disease;53
7.1.1.1.1;The Presence of Familial Cases;53
7.1.1.1.2;Concordance in Identical Twins;53
7.1.1.1.3;Ethnic Differences in Incidence;54
7.1.1.1.4;Congenital Disorders with Moyamoya-Like Findings on Angiography;54
7.1.1.2;Approaches to Identify the Moyamoya Disease Genes;54
7.1.1.3;Identification of the First Gene Mutated in Moyamoya Disease;55
7.1.1.4;Conclusions;55
7.1.1.5;References;56
7.2;Chspter 7;58
7.2.1;Genetic Linkage Study;58
7.2.1.1;Chromosome 3p24-26;58
7.2.1.2;Chromosome 6;58
7.2.1.3;Chromosome 8q21-22;59
7.2.1.4;Chromosome 17q25;60
7.2.1.5;Chromosome 17q25.3;60
7.2.1.6;Conclusions;61
7.2.1.7;References;61
7.3;Chapter 8;63
7.3.1;Single Nucleotide Polymorphism and Moyamoya Disease;63
7.3.1.1;Introduction;63
7.3.1.2;Single Nucleotide Polymorphisms: A Brief Review;63
7.3.1.3;Moyamoya Disease and Single Nucleotide Polymorphisms;64
7.3.1.4;Conclusion;64
7.3.1.5;References;64
7.4;Chapter 9;66
7.4.1;HLA Studies in Moyamoya Disease;66
7.4.1.1;Introduction;66
7.4.1.2;HLA and Disease Associations;67
7.4.1.2.1;Genomic Organizations of HLA Genes;67
7.4.1.2.2;Mechanisms of HLA and Disease Associations;67
7.4.1.2.3;Statistical Analysis of HLA and Disease Associations;68
7.4.1.3;HLA Studies in MMD;68
7.4.1.3.1;HLA Class I Alleles Associated with MMD;68
7.4.1.3.2;HLA Class II Alleles Associated with MMD;69
7.4.1.3.3;Implications of HLA Associations with MMD;70
7.4.1.3.4;References;71
8;Part IV: Pathophysiology I: Protein, Cell, and Immunology;72
8.1;Chapter 10;73
8.1.1;Proteins, Cells, and Immunity in the Moyamoya Disease: An Overview;73
8.1.1.1;Introduction;73
8.1.1.2;Proteins;73
8.1.1.3;Cells;75
8.1.1.4;Immunity;76
8.1.1.5;References;77
8.2;Chapter 11;79
8.2.1;Vascular Smooth Muscle Cell-Related Molecules and Cells;79
8.2.1.1;References;81
8.3;Chapter 12;83
8.3.1;Ischemia/Angiogenesis-Related Molecules and Cells;83
8.3.1.1;Ischemia/Angiogenesis-Related Molecules;83
8.3.1.1.1;Fibroblast Growth Factor;83
8.3.1.1.2;Vascular Endothelial Growth Factor;84
8.3.1.1.3;Angiopoietins;85
8.3.1.1.3.1;Angiopoietin 1;85
8.3.1.1.3.2;Angiopoietin 2;85
8.3.1.1.3.3;Angiopoietins 3 and 4;85
8.3.1.1.4;Platelet-Derived Growth Factor;86
8.3.1.1.5;Epidermal Growth Factor;86
8.3.1.1.6;Transforming Growth Factor- b;86
8.3.1.1.7;Tumor Necrosis Factor- a;87
8.3.1.1.8;Integrins;87
8.3.1.1.9;Vascular Endothelial Cadherin;87
8.3.1.1.10;Platelet Endothelial Cell Adhesion Molecule 1;87
8.3.1.1.11;Matrix Metalloproteinases;88
8.3.1.1.12;Other Angiogenic Factors;88
8.3.1.1.13;Angiostatic Factors;88
8.3.1.1.14;MicroRNAs;88
8.3.1.2;Ischemia/Angiogenesis-Related Cells;89
8.3.1.2.1;Endothelial Progenitor Cells;89
8.3.1.2.2;Endothelial Cells;89
8.3.1.2.3;Mural Cells: Pericytes and Smooth Muscle Cells;90
8.3.1.3;References;90
8.4;Chapter 13;92
8.4.1;Immunological Aspects of Moyamoya Disease;92
8.4.1.1;Introduction;92
8.4.1.2;Pathological Evidence;92
8.4.1.3;Association with Autoimmune Diseases;93
8.4.1.4;Association with Infectious Diseases;94
8.4.1.5;Kawasaki, Takayasu, and Moyamoya Disease;94
8.4.1.6;Conclusions;95
8.4.1.7;References;95
9;Part V: Pathophysiology II: Hemodynamics, Biomechanical Aspect;97
9.1;Chapter 14 ;98
9.1.1;Hemodynamics;98
9.1.1.1;Introduction;98
9.1.1.1.1;Definition of a Fluid;98
9.1.1.1.2;Viscosity;99
9.1.1.1.3;Governing Equations (Poiseuille’s Law);100
9.1.1.1.4;Laminar and Turbulent Flows;101
9.1.1.2;Blood Flow in Arteries;102
9.1.1.2.1;Pulsatile Flow;102
9.1.1.2.2;Properties of the Arterial Wall;103
9.1.1.2.3;Vascular Impedance;104
9.1.1.3;Conclusion;106
9.1.1.4;References;106
9.2;Chapter 15;108
9.2.1;Regional Predilection of Lesions and Stages of Moyamoya Disease;108
9.2.1.1;Introduction;108
9.2.1.2;Methods and Hemodynamic Factors That are Crucial to the Study of Regional Predilection of MMD;109
9.2.1.3;How Is the Hemodynamics in Distal ICA and/or BA?;109
9.2.1.4;Could This Hemodynamic Factor of Shear Stress Be an Etiology of This Predilection?;111
9.2.1.5;How Is the Hemodynamic Change Higher According to the Stage of MMD?;112
9.2.1.6;References;112
10;Part VI: Clinical Features;114
10.1;Chapter 16;115
10.1.1;Clinical Features of Moyamoya Disease: An Overview;115
10.1.1.1;Introduction;115
10.1.1.2;Ischemic Attacks;115
10.1.1.3;Intracranial Hemorrhage;116
10.1.1.4;Seizure, Headache, Involuntary Movement and Other Neurologic Symptoms;116
10.1.1.5;References;117
10.2;Chapter 17;118
10.2.1;Headache in Moyamoya Disease;118
10.2.1.1;Introduction;118
10.2.1.2;Headache as the Common Clinical Presentation of Moyamoya Disease;118
10.2.1.3;Headache and Revascularization Surgery;119
10.2.1.4;Conclusion;120
10.2.1.5;References;121
10.3;Chapter 18;122
10.3.1;Involuntary Movement;122
10.3.1.1;Introduction;122
10.3.1.2;Characteristics of the Patients;122
10.3.1.3;Symptoms;123
10.3.1.4;Mechanisms;123
10.3.1.5;Treatment;124
10.3.1.6;Conclusion;124
10.3.1.7;References;124
10.4;Chapter 19;126
10.4.1;Progression of Moyamoya Disease;126
10.4.1.1;Introduction;126
10.4.1.2;Angiographical Progression;126
10.4.1.3;Age and Progression;127
10.4.1.4;Unilateral to Bilateral;127
10.4.1.5;Those Who Are Likely to Progress;127
10.4.1.6;Mechanism of Progression;128
10.4.1.7;Progression of Clinical Sign;130
10.4.1.8;Imaging Studies to Detect Progression;131
10.4.1.9;Influence of Bypass Surgery to Progression;131
10.4.1.10;Conclusions;131
10.4.1.11;References;132
10.5;Chapter 20;134
10.5.1;Systemic Arterial Involvement in Moyamoya Disease;134
10.5.1.1;Introduction;134
10.5.1.2;Prevalence of Renal Arterial Involvement in Moyamoya Disease;134
10.5.1.3;Radiologic and Pathologic Findings of Renal Arteries Involved in Moyamoya Disease;136
10.5.1.4;Treatment of Renovascular Hypertension in Moyamoya Disease;137
10.5.1.5;Other Extracranial Artery Involvement in Moyamoya Disease;138
10.5.1.6;References;138
10.6;Chapter 21;140
10.6.1;Associated Neurosurgical Diseases;140
10.6.1.1;Introduction;140
10.6.1.2;Akin Moyamoya Disease (Quasi-Moyamoya Disease);141
10.6.1.3;Association with Vascular Malformations: Arteriovenous Malformation;141
10.6.1.4;Association with Cavernous Malformation and Venous Malformation;144
10.6.1.5;References;146
11;Part VII: Diagnostic Evaluation I: Morphological Imaging;147
11.1;Chapter 22;148
11.1.1;Overview of Image Diagnosis of Moyamoya Disease;148
11.1.1.1;Digital Subtraction Angiography;148
11.1.1.2;CT Scan;148
11.1.1.3;Magnetic Resonance Image;150
11.1.1.4;Magnetic Resonance Angiography;152
11.1.1.5;3D-CTA;155
11.1.1.6;References;156
11.2;Chapter 23;157
11.2.1;Preoperative and Postoperative MRA;157
11.2.1.1;Diagnostic Criteria for Moyamoya Disease with MRA;157
11.2.1.2;Quality of MRA for the Diagnosis of Moyamoya Disease;158
11.2.1.3;Novel Staging of Moyamoya Disease;159
11.2.1.3.1;MRA Score;159
11.2.1.4;Postoperative MRA;162
11.2.1.5;References;163
11.3;Chapter 24;165
11.3.1;Diagnostic Evaluation: Morphological Imaging MRI;165
11.3.1.1;Introduction;165
11.3.1.2;Importance of MRI/MRA for the Management of Moyamoya Disease;165
11.3.1.2.1;Early Diagnosis;165
11.3.1.2.2;Evaluation of Treatment Strategies;166
11.3.1.2.3;Follow-Up;166
11.3.1.3;Morphological Evaluation;166
11.3.1.3.1;MRI;166
11.3.1.3.2;MRA;169
11.3.1.4;Hemodynamic Evaluation;171
11.3.1.5;Conclusions;172
11.3.1.6;References;172
12;Part VIII: Diagnostic Evaluation II: Functional Imaging;175
12.1;Chapter 25;176
12.1.1;Functional Neuroimagings “Overview”;176
12.1.1.1;Introduction;176
12.1.1.2;15 O-PET;177
12.1.1.3;CBF-SPECT;177
12.1.1.3.1;Stratification of Hemodynamic Cerebral Ischemia Using IMP-ARG Method;180
12.1.1.3.2;Statistical Imaging Analysis Using 3-Dimensional Stereotactic Surface Projections (3D-SSP);181
12.1.1.3.3;Dual-Table ARG Method;183
12.1.1.3.4;Segmental Extraction Estimation;184
12.1.1.3.5;Perfusion MRI/CT;184
12.1.1.4;References;184
12.2;Chapter 26;186
12.2.1;Brain Perfusion SPECT in Moyamoya Disease;186
12.2.1.1;Imaging Techniques;186
12.2.1.1.1;Equipments and Radiopharmaceuticals;186
12.2.1.1.2;Acetazolamide-Stress Study;187
12.2.1.1.3;Imaging Protocols and Analysis Methods;187
12.2.1.2;Clinical Applications;188
12.2.1.2.1;Normal Brain Perfusion SPECT;188
12.2.1.2.2;Hemodynamic Changes in MMD;189
12.2.1.2.3;Preoperative Assessment;189
12.2.1.2.4;Postoperative Assessment;190
12.2.1.3;Other Issues with Spect;191
12.2.1.3.1;Postoperative Hyperperfusion Syndrome;191
12.2.1.3.2;Future Perspectives;192
12.2.1.4;References;192
12.3;Chapter 27;194
12.3.1;Iomazenil SPECT (BZP-Receptor);194
12.3.1.1;Introduction;194
12.3.1.2;Kinetics of Iomazenil and the Indicator of the Intactness of the Cortical Neurons;195
12.3.1.3;Diagnosis of Incomplete Brain Infarction in Moyamoya Disease;196
12.3.1.4;Diagnosis of Higher Brain Dysfunction in Moyamoya Disease;199
12.3.1.5;References;201
12.4;Chapter 28;202
12.4.1;Perfusion Imaging in Moyamoya Disease;202
12.4.1.1;Introduction;202
12.4.1.2;MR Perfusion Imaging;203
12.4.1.3;CT Perfusion Imaging;206
12.4.1.4;Conclusion;208
12.4.1.5;References;208
12.5;Chapter 29;210
12.5.1;Positron Emission Tomography in Moyamoya Disease;210
12.5.1.1;Introduction;210
12.5.1.2;Hemodynamics of Moyamoya Disease as Examined by PET;211
12.5.1.3;Clinical Use of PET for Moyamoya Disease: Limitation and Resolution;212
12.5.1.4;Conclusion;216
12.5.1.5;References;216
13;Part IX: Diagnostic Evaluation III: Electrophysiology;218
13.1;Chapter 30;219
13.1.1;Electroencephalography (EEG) in Moyamoya Disease;219
13.1.1.1;Introduction;219
13.1.1.2;Electroencephalographic Changes in Moyamoya Disease;219
13.1.1.3;Pathophysiology of the Re-Build Up Phenomenon;220
13.1.1.4;Clinical Implications;222
13.1.1.5;Conclusion;222
13.1.1.6;References;222
13.2;Chapter 31;224
13.2.1;Magnetoencephalography (MEG): Its Application to Moyamoya Disease;224
13.2.1.1;Introduction;224
13.2.1.2;MEG Localization of Re-Build-Up Phenomenon;225
13.2.1.3;Hypoxic State Caused by Post-Hyperventilation Respiratory Depression;225
13.2.1.4;MEG as a Possible Diagnostic Indicator of Ischemia in Moyamoya Disease;227
13.2.1.5;References;228
14;Part X: Surgical Technique;229
14.1;Chapter 32;230
14.1.1;Overview;230
14.1.1.1;Introduction;230
14.1.1.2;Development of Surgical Procedures (Direct, Single Indirect, and Combined Bypass Procedures);230
14.1.1.3;Direct Bypass Procedure: STA-MCA Anastomosis with Encephalo-Myo-Synangiosis (Fig. 1 );231
14.1.1.4;Various Kinds of Indirect Bypass Procedure;231
14.1.1.5;Management of Cases of Treatment Failure with Indirect Bypass Procedures;232
14.1.1.6;Selection of the Initial Surgical Procedure;234
14.1.1.7;Conclusion;234
14.1.1.8;References;234
14.2;Chapter 33;237
14.2.1;Moyamoya Disease and Anesthesia in Children;237
14.2.1.1;Introduction;237
14.2.1.2;Diagnosis, Classifications, Treatments and Outcomes;237
14.2.1.2.1;Diagnosis and Classifications;237
14.2.1.2.2;Treatment;238
14.2.1.2.3;Outcomes;238
14.2.1.3;Intraoperative Management;239
14.2.1.3.1;Premedication;239
14.2.1.3.2;Monitoring and Anesthesia;239
14.2.1.4;Postoperative Management;240
14.2.1.5;Conclusions;240
14.2.1.6;References;242
14.3;Chapter 34;244
14.3.1;ACA Territory Reinforcement;244
14.3.1.1;Introduction;244
14.3.1.2;Clinical Presentations and Importance of ACA Territory;244
14.3.1.3;Operations and Outcomes;245
14.3.1.4;Illustrative Case;246
14.3.1.5;Conclusions;249
14.3.1.6;References;249
14.4;Chapter 35;251
14.4.1;PCA Territory Reinforcement;251
14.4.1.1;Omental Transplantation;251
14.4.1.2;Omental Transposition;252
14.4.1.3;Encephaloduroarteriosynangiosis;253
14.4.1.4;Occipital Artery-Posterior Cerebral Artery Anastomosis;253
14.4.1.5;References;254
14.5;Chapter 36;255
14.5.1;Endovascular Treatment of Moyamoya Disease;255
14.5.1.1;Endovascular Treatment of Moyamoya Disease with Hemorrhagic Presentation;255
14.5.1.2;Endovascular Treatment of Intracranial Arterial Stenosis of Moyamoya Disease;258
14.5.1.3;Conclusion;262
14.5.1.4;References;262
15;Part XI: Surgical Outcome;264
15.1;Chspter 37;265
15.1.1;Overview;265
15.1.1.1;Introduction;265
15.1.1.2;Indication and Timing of RV;266
15.1.1.3;Comparison of the Outcomes of Various Revascularization Procedures;268
15.1.1.3.1;Comparison of Outcomes Among Indirect Procedures;268
15.1.1.3.2;Comparison of Outcomes Between Indirect and Combined Procedures;272
15.1.1.3.3;Selection of Surgical Procedure;272
15.1.1.4;Conclusion;273
15.1.1.5;References;274
15.2;Chapter 38;277
15.2.1;Risk Factors for Complication;277
15.2.1.1;Introduction;277
15.2.1.2;Perioperative Cerebral Ischemia;277
15.2.1.3;Cerebral Hyperperfusion;279
15.2.1.4;Risk Factors for Cerebral Hyperperfusion Syndrome;281
15.2.1.5;References;281
15.3;Chapter 39;283
15.3.1;Cognition and Quality of Life;283
15.3.1.1;Introduction;283
15.3.1.2;Pediatric Patients;283
15.3.1.3;Adult Patients;285
15.3.1.4;Conclusions;285
15.3.1.5;References;285
16;Part XII: Special Consideration I;287
16.1;Chapter 40;288
16.1.1;Overview: Issues in Young Children and Adults;288
16.1.1.1;Introduction;288
16.1.1.2;Common Genetic Background of Childhood and Adult-Onset Moyamoya Disease;288
16.1.1.3;Clinical Presentation of Childhood and Adult-Onset Moyamoya Disease;289
16.1.1.4;Diagnosis;289
16.1.1.5;Revascularization Surgery for Moyamoya Disease in Children and Adults;290
16.1.1.6;Difference in the Risk of Surgical Complication Between Children and Adult Patients;291
16.1.1.7;References;293
16.2;Chapter 41;295
16.2.1;Moyamoya Disease in Young Children;295
16.2.1.1;Introduction;295
16.2.1.2;Illustrative Case;296
16.2.1.3;Rapid Progression of Disease;296
16.2.1.4;Surgery-Related Ischemic Complication;297
16.2.1.5;Overall Management Outcome;298
16.2.1.6;Site of the First Surgery: Infarcted Hemisphere Versus Contralateral Noninfarcted Hemisphere;299
16.2.1.7;Future Perspectives: Rapid Revascularization and Screening of High-Risk Patients;299
16.2.1.8;References;300
16.3;Chapter 42;301
16.3.1;Moyamoya Disease in Adult: Management of Hemorrhage;301
16.3.1.1;Overview of Intracranial Hemorrhage in Moyamoya Disease;301
16.3.1.2;Management of Hemorrhagic Moyamoya Disease During the Acute Period;301
16.3.1.3;Prevention of Rebleeding in the Chronic Stage;303
16.3.1.4;Design of the JAM Trial;304
16.3.1.4.1;Patient Eligibility and Randomization;304
16.3.1.4.2;Treatment and Follow-Up;305
16.3.1.4.3;Outcome Events;306
16.3.1.5;Status of the JAM Trial;306
16.3.1.6;References;306
16.4;Chapter 43;307
16.4.1;Moyamoya Disease in Adult: Post-Bypass Symptomatic Hyperperfusion;307
16.4.1.1;Introduction;307
16.4.1.2;Direct Bypass in Adult MMD;308
16.4.1.3;Post-Bypass Symptomatic Hyperperfusion in Adult MMD;308
16.4.1.3.1;Definition;308
16.4.1.3.2;Incidence;310
16.4.1.3.3;Pathophysiology;310
16.4.1.3.4;Clinical Manifestation;312
16.4.1.3.5;Imaging;312
16.4.1.3.6;Exemplary Case;313
16.4.1.3.7;Preoperative Prognostics;314
16.4.1.3.8;Treatment;315
16.4.1.4;Conclusion;317
16.4.1.5;References;317
17;Part XIII: Special Consideration II;319
17.1;Chapter 44;320
17.1.1;Moyamoya Syndrome: Pial Synangiosis;320
17.1.1.1;Introduction;320
17.1.1.2;Incidence and Epidemiology;321
17.1.1.3;Clinical Features and Presentation;321
17.1.1.4;Rationale for Treatment;322
17.1.1.5;Surgical Treatment: Overview;322
17.1.1.6;Pial Synangiosis: Technique;323
17.1.1.7;Pial Synangiosis: Indications;324
17.1.1.8;Perioperative Considerations;326
17.1.1.9;Management Considerations for Subgroups of Patients with Moyamoya Syndrome Which Differ from Moyamoya Disease;326
17.1.1.10;Complications and Follow-Up;327
17.1.1.11;Conclusions;328
17.1.1.12;References;329
17.2;Chapter 45;330
17.2.1;Pregnancy and Delivery in Moyamoya Disease;330
17.2.1.1;Introduction;330
17.2.1.2;Pregnancy and Cerebrovascular Diseases;330
17.2.1.3;Moyamoya Disease and Pregnancy;331
17.2.1.4;Nationwide Survey in Japan on Management of Pregnancy and Delivery in Women with Moyamoya Disease;332
17.2.1.5;Management of Pregnancy and Delivery in Women with Moyamoya Disease;333
17.2.1.6;References;333
17.3;Chapter 46;335
17.3.1;Asymptomatic Moyamoya Disease;335
17.3.1.1;Introduction;335
17.3.1.2;Definition;336
17.3.1.3;Epidemiology;336
17.3.1.4;Radiological Findings;336
17.3.1.5;Outcome;337
17.3.1.6;Conclusions;338
17.3.1.7;References;339
17.4;Chapter 47;340
17.4.1;Hyperthyroidism in Moyamoya Disease;340
17.4.1.1;Introduction;340
17.4.1.2;References;341
17.5;Chapter 48;343
17.5.1;Enhancer of Revascularization, Gene and Stem Cell Therapies;343
17.5.1.1;Introduction;343
17.5.1.2;Gene Therapy for Cerebral Ischemia;344
17.5.1.3;Cell Therapy for Cerebral Ischemia;345
17.5.1.4;Conclusion;346
17.5.1.5;References;346
18;Part XIV: Special Consideration III;349
18.1;Chapter 49;350
18.1.1;Moyamoya Disease in North America;350
18.1.1.1;Introduction;350
18.1.1.2;Epidemiologic Features;351
18.1.1.3;Disease Presentation;352
18.1.1.4;Natural History;354
18.1.1.5;Treatment;354
18.1.1.6;Outcome;355
18.1.1.7;Conclusions;355
18.1.1.8;References;356
18.2;Chapter 50;358
18.2.1;Moyamoya Angiopathy in Europe;358
18.2.1.1;Introduction;358
18.2.1.2;Patients and Methods;359
18.2.1.3;Results and Discussion;361
18.2.1.4;Conclusion;364
18.2.1.5;References;364
18.3;Chapter 51;367
18.3.1;Moyamoya Disease in China;367
18.3.1.1;Introduction;367
18.3.1.2;Pathophysiological Features;367
18.3.1.3;Clinical Presentation;368
18.3.1.4;Treatment;369
18.3.1.5;References;369
19;Part XV: Future Perspectives;371
19.1;Chapter 52;372
19.1.1;Future Perspectives in Moyamoya Disease;372
19.1.1.1;Introduction;372
19.1.1.2;Outcome Evaluation;372
19.1.1.2.1;Clinical Outcome Measurements;372
19.1.1.2.2;Angiographic Evaluation of Revascularization;373
19.1.1.2.3;Hemodynamic Evaluation;374
19.1.1.2.4;Evaluation of Cognitive Function;375
19.1.1.2.5;Functional Status and Quality of Life Measurements;375
19.1.1.3;Treatment Aspects;375
19.1.1.3.1;Current Surgical Methods;375
19.1.1.3.2;Experimental Treatment of Ischemic Injury;376
19.1.1.3.3;Prevention of Disease;376
19.1.1.4;References;377
20;Index;378