Each of the surgical procedures requires approximately three days of hospitalization. The first night after surgery is spent in the intensive care unit. The day after surgery, patients are encouraged to get out of bed and ambulate several times a day. Food is generally offered the day after surgery, starting with liquids and advancing to a regular diet as tolerated.
Post-operatively, patients experience some minor scalp pain from the incision, and some patients may get headaches. Pain medication is routinely prescribed.
The incision is closed with staples or sutures. In adults, these are removed one week after surgery when patients return to clinic. In children, dissolvable sutures are used to minimize procedures that might increase their anxiety. A return visit to our clinic is still scheduled for children even if there are no sutures to remove.
Patients with moyamoya will have minimal restrictions after surgery. They usually don't have their "normal" energy level for a few weeks after surgery. Activities are generally left up to the patients. We recommend that contact sports not be played for several weeks.
Patients take an oral anti-platelet agent, such as daily aspirin, after surgery and for the rest of their lives. This is recommended because it thins the blood, which promotes flow through the grafts. Patients who have stomach problems should use coated aspirin and take it with food. If it's still not tolerated, another drug will generally be prescribed. Birth control pills may put patients at a higher risk of having blood clotting problems, and we recommend that patients with moyamoya not use them. Alternative methods of birth control are fine.
Patients with moyamoya are not restricted from becoming pregnant after surgical treatment. Aspirin is still recommended throughout the pregnancy. The method of delivery is up to the patient and the obstetrician, and we are always happy to communicate with the obstetrician at your request.
- Blood pressure management
The general range for blood pressure should be 110-130 over 70-90. If you are diagnosed with high blood pressure, please put your physician in touch with us before starting treatment so that the plans and goals for blood pressure treatment can be discussed and agreed upon.
Headaches may or may not be related to moyamoya. Patients can be diagnosed after their physician refers them for an MRI due to headaches, but the headaches may not actually be due to moyamoya. If the characteristics of your headaches change after surgery, we should be contacted. However, long-term pain management may be recommended if you have persistent headaches after surgery.
- Non-constrictive devices
Patients who have direct or indirect bypass grafts have a risk of compressing their grafts if they wear eyeglasses or other devices that fit too closely to their heads around the temple area. We will discuss this with you after surgery.
- Long-term follow up
Follow up tests including an angiogram, MRI, blood flow studies and neuropsychological testing are performed at 6 months, 3 years, 10 years and 20 years following surgery. This is to ensure that blood flow is adequate. Unless patients have further symptoms, no other routine follow up studies are usually needed for patients who have had bilateral surgeries.
For patients who have unilateral moyamoya, we recommend an annual CT angiogram or MRI/MRA to look for progression of moyamoya on the other side. However, we like our patients to contact us with an update of their progress at least once a year. If symptoms persist or recur, we want to be contacted as soon a possible.
- Other considerations and restrictions
Patients should always stay well hydrated, drinking between 2-3 liters of non-caffeinated beverages each day.