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Direct extracranial-intracranial bypass for children with moyamoya disease
H Sakamoto1, S Kitano, T Yasui
1Department of Pediatric Neurosurgery, Oaska City General Hospital, Japan.
Insights
Superficial temporal artery-middle cerebral artery (STA-MCA) double bypass with encephalo-myo-synangiosis (EMS) effectively treats Moyamoya disease in children. This surgical approach improves cerebral blood flow and prevents ischemic events, offering a safe and effective treatment option.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Vascular Neurology
Background:
- Moyamoya disease causes progressive stenosis of intracranial arteries, leading to cerebral hypoperfusion and ischemic events, particularly in children.
- Cerebral hypoperfusion in Moyamoya disease increases the risk of transient ischemic attacks (TIAs) and stroke, especially during physiological stress like hyperventilation.
Purpose of the Study:
- To evaluate the safety and efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses combined with encephalo-myo-synangiosis (EMS) for treating pediatric Moyamoya disease.
- To assess the improvement in cerebral blood flow and reduction in ischemic events following this surgical intervention.
Main Methods:
- Surgical procedure involved STA-MCA double anastomoses to cortical arteries in the hypoperfused watershed area, alongside EMS.
- The study included 10 children (19 hemispheres) aged 5-11 years with ischemic Moyamoya disease.
- Preoperative and postoperative angiograms were used to assess cerebral blood flow, and clinical outcomes were monitored.
Main Results:
- Postoperative angiograms showed successful revascularization of the middle cerebral artery territory via the STA branches in all 19 hemispheres.
- No perioperative strokes or major complications were observed; four patients experienced a single TIA within the first month post-surgery.
- Over a mean 4-year follow-up, no hyperventilation-induced ischemic episodes occurred, and no neurological deterioration was noted.
Conclusions:
- STA-MCA double anastomoses combined with EMS provide a safe and effective revascularization strategy for pediatric Moyamoya disease.
- This surgical approach significantly reduces the incidence of ischemic events and improves neurological outcomes in young patients.
- The procedure demonstrates long-term efficacy in restoring cerebral perfusion and preventing further ischemic complications.
Abstract:
To improve cerebral hypoperfusion in the ischemic type of Moyamoya disease, we have applied superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses in combination with encephalo-myo-synangiosis (EMS) for 19 hemispheres of 10 children (age from 5 to 11 years at surgery). Two branches of the STA were anastomosed to the two cortical arteries which were selected in the watershed area of the cerebral hemisphere estimated as a hypoperfusion area on the preoperative angiograms. Before surgery transient ischemic attacks (TIAs) developed from every month to every 6 months in association with hyperventilation or sobbing. No perioperative completed stroke or wound complications was observed, although single TIA developed in four patients within 1 month after surgery. Postoperative angiogram demonstrated that, not only the preoperative watershed area, but also the most of the middle cerebral artery territory was oppacified via the 2 branches of the STA in all 19 hemispheres. In a mean follow-up period of 4 years, no ischemic episode was induced by hyperventilation, and there was no mental or neurological deterioration. STA-MCA double anastomoses, to the cerebral watershed area, in combination with EMS are safe and effective even for younger children with Moyamoya disease.