Key result
Pregnant patients with childhood-onset moyamoya disease who previously underwent bypass surgery had uneventful deliveries with well-preserved collateral blood flow.
Case Report (n=32)
No
Pregnancy and delivery can be safely managed in patients with moyamoya disease who have undergone prior successful bypass surgery with preserved collateral blood flow.
May support individualized counseling in post-bypass moyamoya pregnancies; leaves open need for prospective validation before practice change.
We report 32 female patients in whom moyamoya disease was diagnosed when they were younger than 14 years old. Of these, 29 patients underwent bypass surgery during childhood. Two patients became pregnant at the age of 21 and 22, respectively. Careful follow-up was performed to avoid toxemia, hypertension and excessive increase in body weight. MR angiography revealed well-developed collateral flow through the operated extracranial carotid artery system and no moyamoya vessels. Blood flow study, performed prior to pregnancy in 1 case, showed preserved blood flow and reactivity to acetazolamide. Delivery was uneventfully performed through Cesarean section under general anesthesia at full term. Three other patients underwent bypass surgery when they were older than 20 years old. Of these, 1 became pregnant and uneventfully had a normal delivery. We discuss the clinical problems in managing pregnant patients known to have moyamoya disease prior to pregnancy, suggesting strategies for these patients.
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Kuroda et al. (2001) conducted a case report in Moyamoya disease of childhood onset (n=32). Pregnancy after bypass surgery was evaluated on Delivery outcome. Pregnant patients with childhood-onset moyamoya disease who previously underwent bypass surgery had uneventful deliveries with well-preserved collateral blood flow.
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