[Surgical Approaches to Pediatric Moyamoya Disease]

Area of Science:

• Neurology
• Neurosurgery
• Vascular Neurology

Background:

• Moyamoya disease (MMD) is a chronic, progressive cerebrovascular condition.
• It involves internal carotid artery stenosis and abnormal brain base vasculature.
• MMD affects both children and adults, with peaks in bimodal age distributions.

Purpose of the Study:

• To evaluate the efficacy of surgical revascularization for ischemic Moyamoya disease.
• To highlight the preferred surgical approach for adult and pediatric MMD patients.
• To emphasize the importance of perioperative hemodynamic management in preventing complications.

Main Methods:

• Superficial temporal artery-middle cerebral artery anastomosis with indirect pial synangiosis (combined revascularization) was employed.
• Hemodynamic studies were utilized for perioperative management.
• Focus on managing pediatric patients prone to postoperative hemodynamic complications.

Main Results:

• Combined revascularization provides early hemodynamic improvement and favorable long-term outcomes.
• Pediatric patients may experience intrinsic postoperative hemodynamic complications like watershed shift ischemia.
• Early hemodynamic assessment is critical for successful surgical outcomes.

Conclusions:

• Surgical revascularization, particularly combined revascularization, is a viable treatment for ischemic MMD.
• Close perioperative hemodynamic monitoring is essential for pediatric and adult MMD patients.
• Preventing complications such as perioperative cerebral infarction requires diligent management.