Moyamoya Disease Surgery: Comprehensive Care Strategies for Optimal Recovery

Effective surgical management of Moyamoya disease requires a well-structured care plan that spans the preoperative, intraoperative, and postoperative phases. Each stage plays a crucial role in minimizing complications and supporting long-term neurological recovery. Proper medical supervision and patient-specific interventions are essential to ensure favorable outcomes.

Preoperative Care: Preparing the Body for Surgery

Hydration and blood viscosity control are critical components of pre-surgical preparation. Patients should receive appropriate intravenous or oral fluid therapy to prevent hemoconcentration—a condition where the blood becomes too thick, increasing the risk of ischemic events such as stroke. Maintaining optimal blood fluidity helps preserve cerebral perfusion and reduces the likelihood of preoperative neurological deficits.

In addition to fluid balance, a thorough evaluation of the patient's cardiovascular status is recommended. This includes reviewing medical history, conducting imaging studies like MRI or angiography, and assessing cognitive function. Educating patients and families about the surgical process can also reduce anxiety and improve cooperation during recovery.

Intraoperative Monitoring: Ensuring Stability During Surgery

Precise blood pressure management is vital throughout the surgical procedure. Patients with Moyamoya disease often have compromised cerebrovascular autoregulation, making them highly sensitive to fluctuations in blood pressure. Even brief episodes of hypotension can lead to reduced cerebral blood flow and potentially trigger ischemic stroke.

Anesthesia teams must use continuous hemodynamic monitoring to maintain stable mean arterial pressure. Techniques such as induced hypertension may be employed during bypass procedures to enhance collateral circulation. Close coordination between neurosurgeons, anesthesiologists, and perfusionists ensures real-time adaptation to any physiological changes.

Postoperative Neurological Protection

After revascularization surgery—such as direct or indirect bypass—the brain gradually adjusts to improved blood flow. However, because the cerebral cortex has adapted to chronic low-oxygen conditions, it may become hyperexcitable, increasing the risk of postoperative seizures.

To mitigate this risk, prophylactic antiepileptic drugs (AEDs) are commonly prescribed in the immediate postoperative period. Medications like levetiracetam or phenytoin help stabilize neuronal activity and prevent seizure clusters that could progress to life-threatening status epilepticus. Neurological assessments should be performed regularly to detect early signs of seizure activity or cerebral edema.

Long-Term Recovery and Follow-Up

Ongoing care after discharge is just as important as hospital-based treatment. Patients benefit from structured follow-up appointments involving neurology, neurosurgery, and rehabilitation specialists. Imaging studies such as perfusion MRI or SPECT scans may be used to evaluate the success of revascularization over time.

Lifestyle modifications—including avoiding smoking, managing stress, and controlling hypertension—are encouraged to support vascular health. Physical and occupational therapy may also be recommended, especially if the patient experienced prior strokes or motor deficits.

In conclusion, successful surgical intervention for Moyamoya disease depends on a multidisciplinary approach that emphasizes meticulous perioperative care, vigilant monitoring, and proactive prevention of complications. With proper planning and comprehensive support, patients can achieve significant improvements in both quality of life and neurological function.