Therapeutic effect of multiple burr hole operation combined with dural inversion and periosteal synangiosis for moyamoya disease

Object. To explore the therapeutic effect of multiple burr hole operation combined with dural inversion and periosteal synangiosis for moyamoya disease (MMD). Methods. We used a modified multiple burr hole operation, combined with dural inversion and periosteal synangiosis, in a series of 57 patients with ischemic-type MMD as a sole revascularization procedure. Postoperatively these patients were followed up for 6 months to 3 years. Results. The postoperative clinical outcomes were excellent for 24 patients (42.1%), good for 21 patients (36.8%), fair for 9 patients (15.8%), and poor for 3 patients (5.3%). There was a significant difference between the preoperative and postoperative modified Rankin Scale or mRS scores. The postoperative angiography revealed that there was sufficient neovascularization at 151 of the 160 burr holes. Effective neovascularization was not found at 9 burr holes in 4 patients. The neovascularization derived mainly from the superficial temporal artery and middle meningeal artery, and less from the posterior auricular artery, occipital artery, and deep temporal artery. The postoperative complications included one case of subdural hematoma, one case of subdural effusions, and five cases of postoperative temporary neurological deficits. Conclusion. The multiple burr-hole operation combined with dural inversion and periosteal synangiosis is a simple, safe, and effective treatment for ischemic-type MMD as a sole treatment without supplementary revascularization procedures.