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Preoperative Risks of Cerebral Infarction in Pediatric Moyamoya Disease
Toshiaki Hayashi1, Tomomi Kimiwada1, Hiroshi Karibe2
1Department of Neurosurgery, Miyagi Children's Hospital, Sendai, Japan (T.H., T.K., R.S.).
Insights
Pediatric moyamoya disease patients under 4 years old with high MRA scores face high risks of preoperative stroke. Prompt surgery within 2 months of diagnosis is recommended for these young patients to mitigate infarction risks.
Area of Science:
- Neurology
- Pediatric Neurology
- Vascular Neurology
Background:
- Moyamoya disease is a rare cerebrovascular disorder affecting children.
- Preoperative cerebral infarction is a significant concern in pediatric moyamoya disease, particularly during the waiting period for surgery.
- Limited research exists on risk factors for preoperative infarction in this population.
Purpose of the Study:
- To evaluate clinical and radiological findings in surgically treated pediatric moyamoya patients.
- To identify risk factors for cerebral infarction from disease onset to surgical intervention.
Main Methods:
- Retrospective analysis of 120 hemispheres from 71 pediatric patients (<18 years) with moyamoya disease treated surgically between 2003 and 2019.
- Statistical examination of potential risk factors for preoperative infarction, including age at diagnosis and magnetic resonance angiography (MRA) scores.
- Multivariate and univariate logistic regression analyses were employed.
Main Results:
- Younger age at diagnosis (OR, 0.68) and higher MRA scores (OR, 2.29) were significant risk factors for infarction at diagnosis.
- Risk factors for infarction while awaiting surgery included younger age at diagnosis (OR, 0.61), higher MRA scores (OR, 1.75), and a history of infarction (OR, 40.4).
- Patients under 4 years old had a significantly higher risk of infarction both at diagnosis and while awaiting surgery. Delaying surgery for over 2 months increased infarction risk in patients under 6 years old.
Conclusions:
- Young age at diagnosis and high MRA scores are associated with rapid disease progression and increased preoperative infarction risk.
- Surgery within 2 months of diagnosis is recommended for pediatric moyamoya patients under 4 with high MRA scores and cerebral infarction.
- Further research is needed to establish optimal surgical timing for pediatric moyamoya disease.
Background And Purpose:
In pediatric moyamoya disease, there have been few reports of the risk factors for preoperative cerebral infarction, especially during the waiting period before surgery. The clinical and radiological findings of surgically treated pediatric moyamoya patients were evaluated to analyze the risk factors for cerebral infarction seen from onset to surgery.
Methods:
Between August 2003 and September 2019, 120 hemispheres of 71 patients under 18 years of age with moyamoya disease were surgically treated by direct and indirect bypass procedures. The mean age of all surgical hemispheres at diagnosis was 6.7±3.9 years (6 months–17 years). The potential risk factors for preoperative infarction were examined statistically.
Results:
Multivariate logistic regression analysis showed that risk factors for infarction at the time of diagnosis were age at diagnosis (odds ratio [OR], 0.68 [95% CI, 0.57–0.82]; P<0.0001) and the magnetic resonance angiography (MRA) score (OR, 2.29 [95% CI, 1.40–3.75]; P=0.001). Univariate analysis showed that risk factors for infarction while waiting for surgery were age at diagnosis (OR, 0.61 [95% CI, 0.46–0.80]; P<0.0001), the MRA score (OR, 1.75 [95% CI, 1.26–2.41]; P=0.0003), and onset of infarction (OR, 40.4 [95% CI, 5.08–322.3]; P<0.0001). Multiple comparisons showed that patients under 4 years of age were at a significantly high risk of infarction at the time of diagnosis and while waiting for surgery. Time from diagnosis to surgery of >2 months was a significant risk factor for infarction while waiting for surgery in patients under 6 years of age.
Conclusions:
Young age at diagnosis and a high MRA score may be associated with rapid disease progression and result in preoperative infarction. We recommend that surgery be performed within 2 months of diagnosis for the patients under 4 years of age with a high MRA score (>5) and cerebral infarction. Further study is needed to define the optimal timing of surgery.
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