Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy

Area of Science:

• Neurology
• Pediatric Critical Care
• Anesthesiology

Background:

• Moyamoya arteriopathy poses significant perioperative neurologic risks for pediatric patients, including stroke and transient ischemic attack (TIA).
• Limited research exists on managing these patients, especially during the intensive care unit (ICU) stay post-anesthesia.
• Cerebral hypoperfusion is a primary concern, necessitating careful perioperative management.

Purpose of the Study:

• To develop a multidisciplinary, evidence- and consensus-based periprocedural care pathway for pediatric patients with moyamoya arteriopathy.
• To reduce the incidence of new permanent neurologic deficits, stroke, or TIA in high-risk pediatric moyamoya patients undergoing anesthesia.
• To standardize and improve the perioperative management of these vulnerable patients.

Main Methods:

• Literature review to identify perioperative stroke/TIA risk factors and management strategies for moyamoya patients.
• Formation of a multidisciplinary team including anesthesia, neurocritical care, nursing, child life, neurosurgery, interventional neuroradiology, neurology, and hematology.
• Development of a care pathway classifying patients into high or standard risk categories with individualized plans for high-risk cases.

Main Results:

• A comprehensive care pathway was created for pediatric moyamoya patients undergoing anesthesia.
• The pathway stratifies risk and provides individualized management plans for high-risk patients.
• Future studies will compare neurologic sequelae incidence before and after pathway implementation.

Conclusions:

• A multidisciplinary care pathway is essential for managing pediatric moyamoya arteriopathy patients perioperatively.
• This pathway aims to mitigate the risk of neurologic deficits, stroke, and TIA in this high-risk population.
• Standardized care pathways can improve outcomes for children with moyamoya undergoing anesthesia.