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Pregnancy and delivery in moyamoya vasculopathy: experience of a single European institution

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Abstract

Moyamoya vasculopathy (MMV) is a stenoocclusive cerebrovascular disease frequently affecting adolescent females. Thus, the management of pregnancy is of major interest for physicians dealing with MMV patients. However, clinical data concerning pregnant MMV patients is lacking. Our aim was to analyze the course of pregnancy in our European MMV patient cohort. We retrospectively identified MMV patients with a history of pregnancy who were treated in our institution. We analyzed demographic data, clinical symptoms, treatment, and detailed history of pregnancies. We identified 31 MMV patients (81% moyamoya disease (MMD), 6% unilateral MMD, 13% quasi MMD) with a history of pregnancy resulting in a total of 60 pregnancies and 48 deliveries. Ninety-four percent of the patients became symptomatic by ischemic events and 6% by headache. Eighty-one and nineteen percent of the patients experienced their pregnancies prior to (first group) or after the diagnosis (second group), respectively. In the first group, the mean age at first delivery and bypass treatment were 24 ± 4 and 42 ± 10, respectively. Eight percent of these patients were diagnosed as MMV due to ischemic events during perinatal period. In the second group, the mean age at first delivery and bypass treatment were 26 ± 7 and 23 ± 6, respectively. No cerebral events were reported within perinatal period in this group. All previously operated patients continued their aspirin medication at least until the 3rd trimester. The majority of the pregnancies occurred prior to diagnosis in our European patient cohort. Our data indicates a protective effect of surgical treatment for avoiding cerebral events during pregnancy and delivery for already diagnosed patients.

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Acknowledgements

Dr. Acker is a participant of the BIH-Charité Clinician Scientist Program funded by the Charité – Universitätsmedizin Berlin and the Berlin Institute of Health.

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Authors and Affiliations

  1. Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Güliz Acker, Marcus Czabanka & Peter Vajkoczy

  2. Berlin Institute of Health (BIH), 10178, Berlin, Germany

    Güliz Acker

  3. Department of Neurosurgery, University Hospital Mannheim, Medical Faculty of the University of Heidelberg, Mannheim, Germany

    Peter Schmiedek

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  1. Güliz Acker
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  2. Marcus Czabanka
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  3. Peter Schmiedek
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  4. Peter Vajkoczy
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Correspondence to Peter Vajkoczy.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Number EA1/178/14) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Acker, G., Czabanka, M., Schmiedek, P. et al. Pregnancy and delivery in moyamoya vasculopathy: experience of a single European institution. Neurosurg Rev 41, 615–619 (2018). https://doi.org/10.1007/s10143-017-0901-5

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  • DOI: https://doi.org/10.1007/s10143-017-0901-5

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