Surgical revascularisation for childhood moyamoya

Area of Science:

• Pediatric Neurology
• Neurosurgery
• Vascular Neurology

Background:

• Moyamoya disease (MM) poses a significant risk of recurrent arterial ischaemic stroke (AIS) and neurological complications in children.
• Surgical revascularisation (SR) is a potential intervention to mitigate these risks.

Purpose of the Study:

• To evaluate the safety and efficacy of surgical revascularisation (SR) in children diagnosed with moyamoya disease (MM).
• To assess the rate of recurrent AIS and transient ischaemic attacks (TIAs) following SR in a pediatric cohort.

Main Methods:

• Retrospective review of medical records and radiological imaging for children with MM who underwent SR.
• Analysis of 134 SR procedures (82 indirect, 49 direct) in 73 children, with a median follow-up of 34 months.

Main Results:

• No perioperative mortality was observed. Three children (4.1%) experienced recurrent AIS after SR.
• Transient ischaemic attacks (TIAs) showed improvement in 79.2% of cases.
• Two patients with sickle cell disease developed intracranial haemorrhage post-SR.

Conclusions:

• Surgical revascularisation (SR) is a safe procedure for pediatric moyamoya disease (MM), comparable to other major series.
• The rate of recurrent AIS post-SR is lower than expected based on the natural history of MM.
• No significant difference in recurrent AIS outcomes was noted between direct and indirect SR procedures.