Transcranial revascularisation in childhood and adolescence

Fifteen patients under the age of 20 years underwent transcranial revascularisation surgery: 13 presented with acute strokes or recurrent transient neurological events, one with progressive dementia and one with recurrent syncope. Five underwent unilateral and seven bilateral anastomosis of the superficial temporal artery to a branch of the middle cerebral artery (STA-MCA bypass). One patient aged 22 months underwent bilateral encephaloduroarterisynangiosis (EDAS). Three patients deteriorated postoperatively: one died from a probable cardiac cause, one had subarachnoid haemorrhage and the patient who underwent EDAS suffered further permanent ischaemic damage. No further permanent ischaemic events occurred following STA-MCA bypass (median follow-up 41 months). Transient ischaemic events persisted postoperatively in four cases, but with reduced severity. The results suggest that STA-MCA bypass may be effective in protecting young patients from further permanent ischaemic events in the treated vascular territory.