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Moyamoya disease associated with a brain stem glioma
S Kitano1, H Sakamoto, K Fujitani
1Department of Pediatric Neurosurgery, Osaka City General Hospital, Japan.
Abstract:
An 8-year-old boy was found to have primary moyamoya disease associated with a brain stem glioma. For over 3 years the child had experienced transient ischemic attacks induced by hyperventilation. One month before referral to our hospital he had presented with progressive left facial nerve palsy. Magnetic resonance imaging showed a cystic mass in the lower pons. Angiography revealed severe bilateral stenosis of the internal carotid arteries and prominent moyamoya vessels in the basal ganglia. Partial resection of the tumor yielded a histological diagnosis of pilocytic astrocytoma. Local radiation therapy reduced the size of the tumor. Anastomosis of the superficial temporal arteries and middle cerebral arteries on both sides was then performed. After direct bypass surgery, the patient remained in a good condition for a 5-year follow-up period. Clinical investigation of the coincidence of primary moyamoya disease and brain stem glioma led the authors to conclude that these two diseases coexisted independently.
Insights
This study reports a rare case of a child with moyamoya disease and brain stem glioma, treated successfully with surgery and radiation. The findings suggest these conditions can coexist independently.
Area of Science:
- Neurology
- Pediatric Neurosurgery
Background:
- Moyamoya disease is a rare cerebrovascular disorder.
- Brain stem gliomas are tumors affecting the brainstem.
- The co-occurrence of these conditions is exceptionally rare.
Observation:
- An 8-year-old boy presented with transient ischemic attacks and facial nerve palsy.
- Imaging revealed moyamoya disease and a brain stem glioma (pilocytic astrocytoma).
Findings:
- The patient underwent tumor resection, radiation, and surgical revascularization (superficial temporal artery to middle cerebral artery bypass).
- The patient showed a good clinical condition during a 5-year follow-up.
- The study concluded that moyamoya disease and brain stem glioma can coexist independently.
Implications:
- This case highlights the importance of considering multiple pathologies in complex pediatric neurological cases.
- Successful multimodal treatment strategies can be effective for such rare coexisting conditions.
- Further research may elucidate potential shared risk factors or independent occurrences.