Related Experiment Video
Updated: Jul 4, 2026
Lateral Chronic Cranial Window Preparation Enables In Vivo Observation Following Distal Middle Cerebral Artery Occlusion in Mice
Published on: December 29, 2016
Effect of preoperative skull block on pediatric moyamoya disease
Hyun Joo Ahn1, Jie Ae Kim, Jeong Jin Lee
1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Kangnam-Gu, Seoul, Korea. hyunjooahn@skku.edu
Insights
A preoperative skull block in pediatric moyamoya surgery improved hemodynamic control and pain relief. This nerve block technique reduced delirious awakening and may lower the risk of postoperative neurological complications in patients undergoing encephaloduroarteriomyosynangiosis.
Area of Science:
- Neurosurgery
- Pediatric Anesthesiology
- Neurology
Background:
- Stable hemodynamics, normocapnia, and adequate pain relief are crucial for reducing neurological complications in pediatric moyamoya disease patients undergoing encephaloduroarteriomyosynangiosis (EDAMS).
- Preoperative skull blocks may mitigate hemodynamic fluctuations, ventilation issues from emergence delirium or oversedation, and enhance pain management, potentially lowering postoperative morbidity.
Purpose of the Study:
- To evaluate the efficacy of a preoperative skull nerve block in pediatric patients undergoing EDAMS surgery for moyamoya disease.
- To assess the impact of the nerve block on hemodynamic stability, emergence characteristics, pain management, and postoperative neurological morbidity.
Main Methods:
- A randomized controlled trial involving pediatric patients (3-13 years) undergoing EDAMS surgery.
- The nerve block (NB) group received a preoperative skull block (bupivacaine and methylprednisolone) targeting specific cranial nerves, while the control group did not.
- General anesthesia with sevoflurane was administered to all patients.
Main Results:
- The NB group exhibited more stable hemodynamics with lower sevoflurane requirements.
- The control group had a significantly higher incidence of delirious awakening (OR 4.9), increased pain, and greater analgesic needs post-operatively.
- While arterial CO2 levels did not differ, the NB group showed reduced 24-hour postoperative morbidity (cerebral infarction, ischemic deficits) with an odds ratio of 3.2 compared to the control group.
Conclusions:
- Preoperative skull block facilitates easier hemodynamic control, promotes calmer emergence, and improves pain relief in pediatric EDAMS surgery.
- The nerve block technique appears to be associated with reduced postoperative neurological complications, suggesting its benefit in managing moyamoya disease patients.
Object:
Stable hemodynamics, normocapnia, and adequate pain relief are considered important factors in the reduction of neurological complications in pediatric patients undergoing encephaloduroarteriomyosynangiosis (EDAMS) operations for the treatment of moyamoya disease. A preoperative skull block may reduce hemodynamic fluctuations and hypo- or hyperventilation due to emergence delirium or oversedation and provide adequate pain relief, thereby reducing postoperative morbidity.
Methods:
Pediatric patients (age 3-13 years) undergoing EDAMS surgery for moyamoya disease were randomly divided into a nerve block (NB) group (18 cases) or control group (21 cases). The treatment group patients received a preoperative NB (0.25% 5-8 ml bupivacaine mixed with 20-40 mg methylprednisolone) targeting the supraorbital, supratrochlear, auriculotemporal, and posterior auricular nerves. Patients in the control group did not receive NB. General anesthesia with sevoflurane was induced in both groups.
Results:
In the NB group, stable hemodynamic parameters were obtained with a lower sevoflurane concentration than in the control group. For delirious awakening, the odds ratio in the control group was 4.9 compared with the NB group. Pain and analgesic requirement were higher in the control patients than in the NB-treated patients during the postanesthesia care unit stay. However, the arterial CO(2) tension in the postanesthesia care unit did not differ between the 2 groups. The odds ratio in the control group for the rate of morbidity (cerebral infarction and reversible ischemic neurological deficits) during the first 24 hours following the operation was 3.2 compared with the NB group.
Conclusions:
The use of skull block during EDAMS surgery provided easy hemodynamic control, calm awakening, and better pain relief and may be related to the reduced postoperative morbidity.
