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Low Incidence of Neurological Adverse Events Among Pediatric Patients With Moyamoya Undergoing General Anesthesia for

Shiri Zarour1, Nitzan Zohar1, Jonathan Roth2

  • 1Division of Anesthesia, Intensive Care, and Pain, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel.

Pediatric Neurology
|October 10, 2024
PubMed
Abstract

Insights

General anesthesia for pediatric Moyamoya disease (MMA) patients undergoing nonrevascularization procedures is safe when prepared with hyperhydration. Neurological adverse events (NAEs) were rare, particularly after diagnostic imaging, offering reassurance to families.

Area of Science:

  • Pediatric Neurology
  • Anesthesiology
  • Neurovascular Diseases

Background:

  • General anesthesia (GA) carries risks for patients with Moyamoya disease (MMA).
  • The specific risks of GA for nonrevascularization procedures in pediatric MMA patients are not well-defined.
  • Limited data exist on neurological adverse events (NAEs) in this population undergoing nonrevascularization.

Purpose of the Study:

  • To determine the incidence of NAEs in pediatric patients with MMA undergoing GA for nonrevascularization procedures.
  • To assess the safety profile of GA in this specific clinical context.
  • To provide data to inform clinical decision-making and patient counseling.

Main Methods:

  • Retrospective cohort study at a tertiary pediatric center.
  • Included patients aged ≤18 years with MMA undergoing GA for nonrevascularization procedures (Jan 2014-July 2023).
  • NAEs defined as transient ischemic attacks, seizures, altered mental status, severe headache, or arterial ischemic stroke (AIS) within 30 days postprocedure.

Main Results:

  • 149 procedures in 38 patients (median age 8.3 years; 57% female).
  • Most procedures were imaging studies (83.2%); 16.8% were surgical.
  • One NAE (0.67%) occurred (AIS after shunt revision) in a complex patient despite hyperhydration; no NAEs after imaging studies.

Conclusions:

  • General anesthesia for nonrevascularization procedures in pediatric MMA patients prepared with hyperhydration appears safe.
  • The low incidence of NAEs, especially after imaging, is reassuring.
  • This information is valuable for managing patient and family expectations regarding procedural risks.
Keywords:
General anesthesiaMoyamoya angiopathyNeurological adverse eventsStrokeTIA

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