Tailored Surgical Approach for Moyamoya in Very Young Children: A Single-Center Retrospective Analysis and Algorithm...

Area of Science:

• Neurology
• Neurosurgery
• Pediatric Cerebrovascular Disease

Background:

• MoyaMoya Disease (MMD) and MoyaMoya Syndrome (MMS) are progressive cerebrovascular disorders.
• Surgical intervention guidelines for pediatric MMD/MMS, especially in children under 3, are limited.
• Early onset in young children (<3 years) is associated with poorer prognoses.

Purpose of the Study:

• To propose an optimized treatment algorithm for surgical revascularization in pediatric MMD/MMS.
• To focus on a high-risk subgroup of children younger than 3 years.
• To leverage institutional experience to guide surgical strategies.

Main Methods:

• Retrospective analysis of pediatric patients (<3 years) undergoing surgical revascularization for MMD/MMS (Jan 2015 - Jul 2023).
• Data collection included demographics, clinical presentation, surgical techniques, complications, and outcomes.
• Evaluation of surgical approaches (indirect, direct, combined) and follow-up assessments.

Main Results:

• Sixteen patients (mean age 2.1 years) underwent surgery; common symptoms included TIA, seizures, and intellectual disability.
• 75% had preoperative ischemic lesions; 5 involved posterior circulation.
• At follow-up (mean age 5.6 years), 50% were asymptomatic, 66% showed improved perfusion on MRI, and 2 progressed.

Conclusions:

• Children under 3 with MMD/MMS exhibit aggressive disease with higher risks of infarction and stroke.
• Delayed surgery in this vulnerable population correlates with poor outcomes.
• Early surgical intervention using indirect or combined revascularization, guided by a tailored algorithm, is supported.