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Effect of Revascularization on Headache Associated with Moyamoya Disease in Pediatric Patients
Insights
Headache is common in childhood moyamoya disease (MMD). Revascularization surgery significantly improved headache in 87.5% of pediatric patients, suggesting a link between cerebral hemodynamics and MMD headaches.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Vascular Neurology
Background:
- Episodic headache is a frequent symptom in childhood moyamoya disease (MMD).
- The underlying mechanisms, causes, and surgical impact on headaches in pediatric MMD remain unclear.
- Understanding these factors is crucial for effective patient management.
Observation:
- This study evaluated 10 pediatric patients (under 18) with MMD who underwent revascularization surgery.
- Cerebral blood flow was assessed using IMP-SPECT imaging before and after surgery.
- Headache frequency and neurological deficits were monitored during a mean follow-up of 32.9 months.
Findings:
- Revascularization surgery led to improved cerebral blood flow in 14 of 15 revascularized hemispheres.
- Significant headache improvement was observed in 87.5% (7 of 8) of patients experiencing headaches.
- All patients showed good outcomes with resolution of ischemic neurological deficits.
Implications:
- Headache in pediatric MMD is strongly associated with altered cerebral hemodynamics.
- Revascularization strategies, including combined direct and indirect bypass, appear effective in alleviating headaches.
- These findings support surgical intervention for managing headaches in children with MMD.
Abstract:
Episodic headache is common in childhood moyamoya disease (MMD). The onset, mechanism, cause of headache and the effect of revascularization surgery on headache are not yet clear. We studied 10 cases of children (7 boys and 3 girls) younger than 18 years who underwent revascularization for MMD between 2009 and 2013. We evaluated frequency of headache and cerebral blood flow changes by single photon emission computed tomography brain imaging with [I123]-labeled iofetamine (IMP-SPECT) before and after surgery. Patients' ages ranged from 0 to 15 years at onset and 2 to 17 years at the time of surgery, mean age being 6.7 and 8.0 years respectively. 9 of 10 patients presented with ischemic symptoms and 8 had headache. 5 patients underwent indirect bypass and 5 underwent combined direct and indirect bypass. Cerebral blood flow improvement was obtained in 14 of the 15 cerebral hemispheres revascularized. The mean follow-up duration was 32.9 months. All the patients had good outcomes with improvement of ischemic neurological deficits. Headache improved in 7 (87.5%) of 8 patients. Headache in pediatric moyamoya disease is associated with change in cerebral hemodynamics. Revascularization including combined direct bypass and indirect techniques may be required to reduce headache in patients with MMD.
