caa a22 4500 60621447X CHVBK 20210128101053.0 cr unu---uuuuu 210128e20150701xx s 000 0 eng 10.1007/s00701-015-2422-8 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2422-8 Moyamoya disease concurrent with Graves' disease treated by direct bypass: clinical features and treatment strategies [Elektronische Daten] [Bikei Ryu, Takakazu Kawamata, Koji Yamaguchi, Akitsugu Kawashima, Masami Ono, Yoshikazu Okada] Background: Moyamoya disease (MMD) concurrent with Graves' disease (GD) is rare. There is no guideline about optimizing thyroid hormones and the appropriate timing of surgical treatment for MMD with GD. Methods: We encountered eight patients with MMD and GD presenting with cerebral ischemia who were treated by direct bypass. Thyroid hormones [free thyroxin (fT4) and free triiodothyronine (fT3)], thyroid-stimulating hormone (TSH), and TSH receptor antibody (TRAb) were measured sequentially. After thyrotoxic conditions were medically optimized, revascularization surgery was performed by superficial temporal artery-middle cerebral artery (STA-MCA) double bypass in all cases. Clinical outcomes were estimated by modified Rankin scale (mRS) at discharge and 3months after surgery. Results: In six patients with thyrotoxicosis, the fT4, fT3, and TRAb (range) at the onset of cerebral ischemia were 4.81-10.30pg/ml, 13.08-31.90pg/ml, and 3.5-83.8IU/l, respectively. At surgery, mean (range) fT3 and fT4 were optimized to 3.02 (1.01-4.87) pg/ml and 1.09 (0.41-1.68) ng/dl, respectively. In the thyrotoxic cases, it took 70-310 days (mean, 142days) to optimize thyroid hormones before surgery. There was no neurological aggravation after surgery, and outcome was excellent at 3months with mRS scores ≤2 in all cases. Conclusions: For MMD concurrent with GD, optimizing thyroid hormones followed by STA-MCA double bypass was successful to prevent cerebral ischemic events. Springer-Verlag Wien, 2015 Direct bypass nationallicence Graves' disease nationallicence Moyamoya disease nationallicence Superficial temporal artery-middle cerebral artery anastomosis nationallicence Thyroid storm nationallicence Thyrotoxic nationallicence Ryu Bikei Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut Kawamata Takakazu Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut Yamaguchi Koji Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut Kawashima Akitsugu Department of Medicine II, Tokyo Women's Medical University, Tokyo, Japan aut Ono Masami Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut Okada Yoshikazu Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut Acta Neurochirurgica Springer Vienna 157/7(2015-07-01), 1095-1102 0001-6268 157:7<1095 2015 157 701 https://doi.org/10.1007/s00701-015-2422-8 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2422-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Ryu Bikei Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut NATIONALLICENCE 700 1- Kawamata Takakazu Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut NATIONALLICENCE 700 1- Yamaguchi Koji Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut NATIONALLICENCE 700 1- Kawashima Akitsugu Department of Medicine II, Tokyo Women's Medical University, Tokyo, Japan aut NATIONALLICENCE 700 1- Ono Masami Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut NATIONALLICENCE 700 1- Okada Yoshikazu Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, 162-8666, Shinjuku-ku, Tokyo, Japan aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/7(2015-07-01), 1095-1102 0001-6268 157:7<1095 2015 157 701