Intrapartum epidural analgesia for patients with moyamoya disease

There remains some controversy regarding the delivery rout, via cesarean section or vaginal, for pregnant patients with Moyamoya disease. We have set vaginal delivery under epidural analgesia as the first choine of delivery rout in our department of perinatology, at the National Cardiovascular Center. Since 1982, we have experienced 23 deliveries in patients with Moyamoya disease for 26 years. Three cases were transferred after brain hemorrhagic stroke, of whom one pregnant women finally died. Of the remaining 20 cases, 16 (80%) received epidural analgesia and resulted in successful deliveries without complications for mothers and infants. In the other 4 cesarean cases, all of the indication for cesarean were obstetrical, including 2 cases of preeclampsia complaining at headache. Although our clinical experience seems permissive, it should be noticed that our epidural vaginal policy can only be applied to the limited number of institutes where the obstetrical and neruosurgical departments are well connected.