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Cerebral revascularization using gracilis muscle transplantation for childhood moyamoya disease
H Touho1, J Karasawa, H Ohnishi
1Department of Neurosurgery, Osaka Neurological Institute, Japan.
Insights
Gracilis muscle transplantation effectively treated ischemia in children with moyamoya disease affecting cerebral arteries. This surgical revascularization led to symptom resolution in most patients, offering a promising treatment option.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Surgery
Background:
- Moyamoya disease in children can cause cerebral artery ischemia.
- Omental transplantation is a known treatment for moyamoya disease.
- This study explores gracilis muscle transplantation as an alternative revascularization technique.
Observation:
- Six children (ages 3-13) with moyamoya disease underwent gracilis muscle transplantation.
- Procedures targeted anterior or posterior cerebral artery territories.
- Follow-up averaged 15.2 months.
Findings:
- Gracilis muscle transplantation to posterior cerebral artery territories resolved transient visual disturbances in all three patients.
- Gracilis muscle transplantation to anterior cerebral artery territories resolved symptoms in two of three patients.
- One patient still experienced reduced transient paraparesis after anterior circulation surgery.
Implications:
- Gracilis muscle transplantation is a viable surgical revascularization strategy for moyamoya disease.
- This technique can effectively manage cerebral artery ischemia in pediatric moyamoya patients.
- Further research may validate gracilis muscle transplantation for moyamoya disease management.
Background:
Omental transplantation is effective in the management of ischemia in the territories of the anterior and posterior cerebral arteries in childhood moyamoya disease. We introduced a surgical revascularization using gracilis muscle transplantation to these territories.
Methods:
Between January 1991 and May 1993, six children with moyamoya disease, between the age of 3 and 13 years, underwent gracilis muscle transplantation to the territory of either the anterior or the posterior cerebral artery. The mean period of follow-up after surgery was 15.2 months, with a range of 5 to 32 months. Three of the six patients had suffered from frequent transient visual disturbance and were treated with unilateral or bilateral gracilis muscle transplantation to the territory of the posterior cerebral artery. The other three patients had suffered from frequent transient paraparesis, mental retardation, and/or rectal and urinary incontinence, and were treated with gracilis muscle transplantation bilaterally to the territories of the anterior cerebral arteries.
Results:
All three patients with gracilis muscle transplantation unilaterally or bilaterally to the occipital lobes manifested complete disappearance of their symptoms. Two of the three patients with gracilis muscle transplantation bilaterally to the frontal lobes also manifested complete disappearance of their symptoms. The remaining patient who underwent the transplantation bilaterally to the frontal lobes, continued to have episodes of transient paraparesis, postsurgically, but the frequency of symptoms was markedly decreased.
Conclusions:
Ischemia in the territories of the anterior and/or posterior cerebral arteries could be overcome with the use of gracilis muscle transplantation in childhood moyamoya disease.