ACA territory reinforcement

Abstract

Moyamoya disease (MMD) usually involves the middle cerebral artery (MCA) and the anterior cerebral artery (ACA) territories [1]. The areas of frontal lobe supplied by ACA are cardinal for lower extremity motor function, sphincter functions, and especially neuro-cognitive development in children. It is well known that the cerebral cortex supplied by the ACA has many important roles in neuropsychological and intellectual developments in addition to lower extremity motor function and sphincter function [2]. Consequently, ischemic brain insults in the ACA territory may lead to poor intellectual outcomes and low quality of life (QoL) status as well as motor weakness or sphincter dysfunction [2-4]. Nevertheless, many cerebral blood flow studies [4, 5] using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) with acetozolamide have revealed that cerebral blood flow and metabolism in the ACA territory were significantly decreased, and were not adequately compensated by collateral flow from the external carotid arteries (ECAs), MCA, or posterior cerebral artery (PCA). The majority of previous studies have focused on the augmentation of blood flow in the MCA territory [6]. The reinforcement of the ACA territory might to be kept in mind when making the treatment plan for pediatric MMD patients. © 2010 Springer-Verlag Tokyo.