Background Moyamoya disease is a progressive neurovascular pathology defined by the stenosis of the distal internal carotid artery associated with the development of vascular collaterals. The etiology and the exact anatomy of vascular collaterals is not really studied. The aim of this study is to describe the anatomy of vascular collaterals developed between the ophthalmic artery and the anterior cerebral artery in a population of Moyamoya disease.

Methods All patients treated for a Moyamoya disease from 2004 to 2016 in four neurosurgical centers and with an available cerebral digital subtraction angiography were included. Sixty-three cases were evaluated and only 38 of them presented the inclusion criteria. Two patients presented a unilateral cervical internal carotid occlusion that rendered the analysis of ophthalmic artery collaterals impossible. This study is consequently based on the analysis of 74 cerebral hemispheres.

Results Thirty-eight patients (F/M: 2.8/1, mean age: 40) presented the inclusion criteria. The Suzuki’s stage was 0 in 9 patients (unilateral moyamoya syndrome, 12.2%), I in 10 (13.5%), II in 10 (13.5%), III in 14 (18.9%), IV in 15 (20.3%), V in 5 (6.8%) and VI in 11 (14.9%). The most frequently encountered anastomosis between the ophthalmic artery and a cerebral artery was a branch of the anterior ethmoidal artery (31.1%, 23 hemispheres). In case of proximal stenosis of the anterior cerebral artery, a collateral from the posterior ethmoidal artery could be visible (16 hemispheres, 21.6%). One case (1.4%) of anastomosis between the lacrimal artery and the middle meningeal artery which permitted the vascularization of a middle cerebral artery territory was also noted.

Conclusion Collaterals from the ophthalmic artery are frequent in the Moyamoya disease. Their development depends on the need of perfusion of ACA territories knowing that three another systems of compensation could be present (callosal circle, lepto-meningeal anastomosis and duro-pial anastomosis).

Abbreviations ACA: Anterior Cerebral Artery; DSA: Digital Substraction Angiography; ICA: Internal Carotid Artery; MCA: Middle Cerebral Artery; mRS: modified Rankin Score; OA: Ophthalmic Artery; PCA: Posterior Cerebral Artery; STA: Superficial Temporal Artery.

Disclosure of funding or financial support/industry affiliations

We have no conflict of interest.

Disclosures T. Robert: None. G. Ciccio: None. P. Sylvestre: None. A. Weil: None. S. Smajda: None. C. Chaalala: None. R. Blanc: None. M. Reinert: None. M. Piotin: None. M. Bojanowski: None.