High-risk age for rebleeding in patients with hemorrhagic moyamoya disease

Long-term follow-up study

Motohiro Morioka, Jun ichiro Hamada, Tatemi Todaka, Shigetoshi Yano, Yutaka Kai, Yukitaka Ushio, Robert E. Harbaugh, H. Hunt Batjer, Daniel L. Barrow, Nobuo Hashimoto, Ryuichi Tanaka

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

OBJECTIVE: The prevention of rebleeding is one of the most important issues in the successful treatment of moyamoya disease with hemorrhagic onset. However, the natural course of hemorrhagic moyamoya disease and the characteristics of rebleeding remain unclear. METHODS: To study the natural course of the disease in conservatively treated patients, we analyzed long-term follow-up reports on 36 patients (12 male and 24 female) treated without bypass surgery at our hospitals before 1994 (mean follow-up, 12.7 ± 7.1 yr; range, 2.9-27.0 yr). RESULTS: Of our 36 patients, 22 (61.1%) experienced rebleeding; there were 29 rebleeding episodes. The outcomes in patients with rebleeding were worse than in patients who did not rebleed (P < 0.05); in most cases, unsatisfactory results were attributable to rebleeding. Kaplan-Meier and multivariate analysis of rebleeding-free survival showed that age at onset (>36 yr) was a statistically significant risk factor; sex, hypertension, type of intracranial bleeding, and outcome after the first bleeding episode were not. Although the intervals between the first and subsequent episodes varied, both the rebleeding rate and the number of rebleeding episodes were highest in patients 46 to 55 years old. CONCLUSION: Rebleeding is the most important factor in unsatisfactory outcomes of patients with hemorrhagic moyamoya disease. Rebleeding seems to be age-related; rebleeding occurs at an increased rate when patients reach the age range of 46 to 55 years. Patients with hemorrhagic moyamoya must be followed up throughout their lives, even if their neurological status is excellent.

Original languageEnglish (US)
Pages (from-to)1049-1055
Number of pages7
JournalNeurosurgery
Volume52
Issue number5
StatePublished - May 1 2003

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Moyamoya Disease
Hemorrhage
Intracranial Hypertension

Keywords

  • Hemorrhage
  • Moyamoya disease
  • Natural history
  • Rebleeding

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Morioka, M., Hamada, J. I., Todaka, T., Yano, S., Kai, Y., Ushio, Y., ... Tanaka, R. (2003). High-risk age for rebleeding in patients with hemorrhagic moyamoya disease: Long-term follow-up study. Neurosurgery, 52(5), 1049-1055.

High-risk age for rebleeding in patients with hemorrhagic moyamoya disease : Long-term follow-up study. / Morioka, Motohiro; Hamada, Jun ichiro; Todaka, Tatemi; Yano, Shigetoshi; Kai, Yutaka; Ushio, Yukitaka; Harbaugh, Robert E.; Batjer, H. Hunt; Barrow, Daniel L.; Hashimoto, Nobuo; Tanaka, Ryuichi.

In: Neurosurgery, Vol. 52, No. 5, 01.05.2003, p. 1049-1055.

Research output: Contribution to journalArticle

Morioka, M, Hamada, JI, Todaka, T, Yano, S, Kai, Y, Ushio, Y, Harbaugh, RE, Batjer, HH, Barrow, DL, Hashimoto, N & Tanaka, R 2003, 'High-risk age for rebleeding in patients with hemorrhagic moyamoya disease: Long-term follow-up study', Neurosurgery, vol. 52, no. 5, pp. 1049-1055.
Morioka M, Hamada JI, Todaka T, Yano S, Kai Y, Ushio Y et al. High-risk age for rebleeding in patients with hemorrhagic moyamoya disease: Long-term follow-up study. Neurosurgery. 2003 May 1;52(5):1049-1055.
Morioka, Motohiro ; Hamada, Jun ichiro ; Todaka, Tatemi ; Yano, Shigetoshi ; Kai, Yutaka ; Ushio, Yukitaka ; Harbaugh, Robert E. ; Batjer, H. Hunt ; Barrow, Daniel L. ; Hashimoto, Nobuo ; Tanaka, Ryuichi. / High-risk age for rebleeding in patients with hemorrhagic moyamoya disease : Long-term follow-up study. In: Neurosurgery. 2003 ; Vol. 52, No. 5. pp. 1049-1055.
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abstract = "OBJECTIVE: The prevention of rebleeding is one of the most important issues in the successful treatment of moyamoya disease with hemorrhagic onset. However, the natural course of hemorrhagic moyamoya disease and the characteristics of rebleeding remain unclear. METHODS: To study the natural course of the disease in conservatively treated patients, we analyzed long-term follow-up reports on 36 patients (12 male and 24 female) treated without bypass surgery at our hospitals before 1994 (mean follow-up, 12.7 ± 7.1 yr; range, 2.9-27.0 yr). RESULTS: Of our 36 patients, 22 (61.1{\%}) experienced rebleeding; there were 29 rebleeding episodes. The outcomes in patients with rebleeding were worse than in patients who did not rebleed (P < 0.05); in most cases, unsatisfactory results were attributable to rebleeding. Kaplan-Meier and multivariate analysis of rebleeding-free survival showed that age at onset (>36 yr) was a statistically significant risk factor; sex, hypertension, type of intracranial bleeding, and outcome after the first bleeding episode were not. Although the intervals between the first and subsequent episodes varied, both the rebleeding rate and the number of rebleeding episodes were highest in patients 46 to 55 years old. CONCLUSION: Rebleeding is the most important factor in unsatisfactory outcomes of patients with hemorrhagic moyamoya disease. Rebleeding seems to be age-related; rebleeding occurs at an increased rate when patients reach the age range of 46 to 55 years. Patients with hemorrhagic moyamoya must be followed up throughout their lives, even if their neurological status is excellent.",
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T1 - High-risk age for rebleeding in patients with hemorrhagic moyamoya disease

T2 - Long-term follow-up study

AU - Morioka, Motohiro

AU - Hamada, Jun ichiro

AU - Todaka, Tatemi

AU - Yano, Shigetoshi

AU - Kai, Yutaka

AU - Ushio, Yukitaka

AU - Harbaugh, Robert E.

AU - Batjer, H. Hunt

AU - Barrow, Daniel L.

AU - Hashimoto, Nobuo

AU - Tanaka, Ryuichi

PY - 2003/5/1

Y1 - 2003/5/1

N2 - OBJECTIVE: The prevention of rebleeding is one of the most important issues in the successful treatment of moyamoya disease with hemorrhagic onset. However, the natural course of hemorrhagic moyamoya disease and the characteristics of rebleeding remain unclear. METHODS: To study the natural course of the disease in conservatively treated patients, we analyzed long-term follow-up reports on 36 patients (12 male and 24 female) treated without bypass surgery at our hospitals before 1994 (mean follow-up, 12.7 ± 7.1 yr; range, 2.9-27.0 yr). RESULTS: Of our 36 patients, 22 (61.1%) experienced rebleeding; there were 29 rebleeding episodes. The outcomes in patients with rebleeding were worse than in patients who did not rebleed (P < 0.05); in most cases, unsatisfactory results were attributable to rebleeding. Kaplan-Meier and multivariate analysis of rebleeding-free survival showed that age at onset (>36 yr) was a statistically significant risk factor; sex, hypertension, type of intracranial bleeding, and outcome after the first bleeding episode were not. Although the intervals between the first and subsequent episodes varied, both the rebleeding rate and the number of rebleeding episodes were highest in patients 46 to 55 years old. CONCLUSION: Rebleeding is the most important factor in unsatisfactory outcomes of patients with hemorrhagic moyamoya disease. Rebleeding seems to be age-related; rebleeding occurs at an increased rate when patients reach the age range of 46 to 55 years. Patients with hemorrhagic moyamoya must be followed up throughout their lives, even if their neurological status is excellent.

AB - OBJECTIVE: The prevention of rebleeding is one of the most important issues in the successful treatment of moyamoya disease with hemorrhagic onset. However, the natural course of hemorrhagic moyamoya disease and the characteristics of rebleeding remain unclear. METHODS: To study the natural course of the disease in conservatively treated patients, we analyzed long-term follow-up reports on 36 patients (12 male and 24 female) treated without bypass surgery at our hospitals before 1994 (mean follow-up, 12.7 ± 7.1 yr; range, 2.9-27.0 yr). RESULTS: Of our 36 patients, 22 (61.1%) experienced rebleeding; there were 29 rebleeding episodes. The outcomes in patients with rebleeding were worse than in patients who did not rebleed (P < 0.05); in most cases, unsatisfactory results were attributable to rebleeding. Kaplan-Meier and multivariate analysis of rebleeding-free survival showed that age at onset (>36 yr) was a statistically significant risk factor; sex, hypertension, type of intracranial bleeding, and outcome after the first bleeding episode were not. Although the intervals between the first and subsequent episodes varied, both the rebleeding rate and the number of rebleeding episodes were highest in patients 46 to 55 years old. CONCLUSION: Rebleeding is the most important factor in unsatisfactory outcomes of patients with hemorrhagic moyamoya disease. Rebleeding seems to be age-related; rebleeding occurs at an increased rate when patients reach the age range of 46 to 55 years. Patients with hemorrhagic moyamoya must be followed up throughout their lives, even if their neurological status is excellent.

KW - Hemorrhage

KW - Moyamoya disease

KW - Natural history

KW - Rebleeding

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