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Middle Meningeal Artery Collateralization Patterns and Influencing Factors in Pediatric Moyamoya
Nik Alexander Beti1, Gerasimos Baltsavias2, Monika Hebeisen1,3
1Moyamoya Center, University Children's Hospital Zurich and University of Zurich, Zurich, Switzerland.
Introduction:
The middle meningeal artery (MMArt) is considered to be an important collateral in moyamoya angiopathy; however, an in-depth analysis of the underlying mechanisms directing this collateral formation is missing. The aim of this study was to analyze patterns of activation of MMArt in pediatric patients along with identifying factors influencing these collateral pathways.
Methods:
Retrospective clinical and angiographic data of a pediatric moyamoya cohort managed at a single center were analyzed. Angiographic staging, MMArt activation, and collateral supply via posterior cerebral artery (PCA) were evaluated on cerebral angiograms. Stroke burden was evaluated using cerebral MRI. Associations with angiographic staging, stroke burden, and PCA collateral supply were determined.
Results:
MMArt activation was observed in 49% of patients (n = 101). MMArt anterior division was activated more frequently (31% of all hemispheres). MMArt formed collaterals mostly to the frontal brain. Higher odds of activation of MMArt were observed in advanced anterior angiographic stages (stages 4-5) (OR 4.22, p < 0.001), higher posterior angiographic stages (stages 1-2) (OR 5.75, p < 0.001), longer duration of disease (OR 1.33, p = 0.014), and in cases showing collateral supply from the PCA (OR 3.39, p < 0.003). Age at symptom onset, stroke burden, and type of angiopathy (moyamoya disease/syndrome) were not associated with MMArt activation.
Conclusion:
The MMArt serves as a crucial collateral in pediatric moyamoya, particularly to the frontal lobes. Increased MMArt activation is seen in advanced angiopathy with prolonged disease duration and PCA-derived collaterals. Stroke burden and angiopathy subtype do not appear to influence MMArt activation.
Insights
The middle meningeal artery (MMArt) is a key collateral in pediatric moyamoya, especially to the frontal lobes. Its activation is linked to advanced disease stages, longer duration, and posterior cerebral artery (PCA) collaterals, but not stroke burden or moyamoya type.
Area of Science:
- Neurology
- Vascular Neurology
- Pediatric Neurology
Background:
- The middle meningeal artery (MMArt) is a recognized collateral pathway in moyamoya angiopathy.
- Mechanisms of MMArt activation and its role in pediatric moyamoya require further investigation.
Purpose of the Study:
- To analyze MMArt activation patterns in pediatric moyamoya patients.
- To identify factors influencing MMArt collateral formation in this cohort.
Main Methods:
- Retrospective analysis of clinical and angiographic data from pediatric moyamoya patients.
- Evaluation of MMArt activation, angiographic staging, and posterior cerebral artery (PCA) collateral supply.
- Assessment of stroke burden using cerebral MRI.
Main Results:
- MMArt activation occurred in 49% of patients, predominantly its anterior division, supplying the frontal brain.
- Increased MMArt activation correlated with advanced anterior and posterior angiographic stages, longer disease duration, and PCA collateral supply.
- No association was found between MMArt activation and age at onset, stroke burden, or moyamoya disease/syndrome subtype.
Conclusions:
- The MMArt is a significant collateral pathway in pediatric moyamoya, primarily serving the frontal lobes.
- Advanced angiopathy, prolonged disease, and PCA collaterals are associated with increased MMArt activation.
- Stroke burden and moyamoya subtype do not influence MMArt activation.
