Intelligence in children with moyamoya disease: evaluation after surgical treatments with special reference to changes in cerebral blood flow.

Ishii, Ryoji; Takeuchi, Shigekazu; Ibayashi, Katsuhiko; Tanaka, Ryuichi

doi:10.1161/01.str.15.5.873

Cited by 61 publications

(54 citation statements)

References 15 publications

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“…54,[57][58][59][60][61] We found that the stroke recurrence risk was highest in the first year after diagnosis (18%) and that it decreased to 5% per year thereafter into the fifth year. The 5-year stroke recurrence risk is similar for medical and surgical treatment overall, although the data suggest that stroke incidence may be reduced by surgery after the first year.…”

Section: Discussionmentioning

confidence: 76%

Clinical Features of Moyamoya Disease in the United States

Chiu

Shedden²,

Bratina

et al. 1998

Stroke

297

189

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Background and Purpose-We report the clinical features and longitudinal outcome of the largest cohort of patients with moyamoya disease described from a single institution in the western hemisphere. Moyamoya disease in Asia usually presents with ischemic stroke in children and intracranial hemorrhage in adults. Methods-Our study population included all patients with moyamoya disease evaluated at a university hospital in Houston,Texas from 1985 through 1995 (nϭ35). We used Kaplan-Meier methods to estimate individual and hemispheric stroke risk by treatment status (medical versus surgical). Predictors of neurological outcome were assessed. Results-The ethnic background of our patients was representative of the general population in Texas. The mean age at diagnosis was 32 years (range, 6 to 59 years). Ischemic stroke or transient ischemic attack was the predominant initial symptom in both adults and children. Of the 6 patients with intracranial hemorrhage, 5 had an intraventricular site of hemorrhage. The crude stroke recurrence rate was 10.3% per year in 116 patient-years of follow-up. Twenty patients underwent surgical revascularization, the most common procedure being encephaloduroarteriosynangiosis. The 5-year risk of ipsilateral stroke after synangiosis was 15%, compared with 20% for medical treatment and 22% overall for surgery. Conclusions-Our observations indicate that moyamoya disease may have a different clinical expression in the UnitedStates than in Asia, and may demonstrate a trend toward a lower stroke recurrence rate and better functional outcome after synangiosis. (Stroke. 1998;29:1347-1351.)

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Section: Discussionmentioning

confidence: 76%

Clinical Features of Moyamoya Disease in the United States

Chiu

Shedden²,

Bratina

et al. 1998

Stroke

297

189

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“…[3,8,9,11,[15][16][17][18] Cerebral ischemia in this region can in fact lead to lower extremity motor weakness and to intellectual and neuropsychological dysfunction. [11,[17][18][19][20][21] Although little is known about the natural history of MMV, steep decline of neurocognitive performance has been described in 44% of the pediatric population. [20] Furthermore, there is growing evidence that decreased CBF, especially in the frontal lobes, is correlated with diminished intelligence.…”

Section: Discussionmentioning

confidence: 99%

“STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis” as a one-staged revascularization strategy for pediatric moyamoya vasculopathy

et al. 2015

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PURPOSE Moyamoya vasculopathy progressively compromises cerebral blood flow resulting in chronic hypoperfusion. The middle cerebral artery (MCA) territory and the bifrontal areas are the regions most frequently affected. Although most techniques aim to only revascularize the MCA territory, augmentation of blood flow of the bifrontal areas is of importance in the pediatric moyamoya population since these regions play an important role in cognition, intellectual development, and in lower extremity and sphincter function. We recently described a one-staged surgical procedure combining revascularization of three regions, the MCA territory unilaterally and the frontal areas bilaterally. The purpose of this article is to report our surgical experience in eight children and to emphasize the rational for bifrontal revascularization. METHODS We report a case series consisting of eight children where the following surgical strategy was applied: (1) a direct superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass with encephalo-duro-myo-synangiosis (EDMS) for unilateral MCA revascularization; in combination with (2) a bifrontal encephalo-duro-periosteal-synangiosis (EDPS) for bifrontal revascularization. Patients' characteristics and 30-day follow-up data are reported. RESULTS The patient group consisted of six girls and two boys (mean age 10.0, range 4.2-17.5 years): six children presented with moyamoya disease, two with moyamoya syndrome. We performed a one-staged revascularization of one MCA territory and both frontal areas in all patients. No significant complications occurred. Two patients experienced postoperative focal seizures, successfully treated with anti-epileptic medication. CONCLUSIONS The single-staged STA-MCA bypass with EDMS combined with bifrontal EDPS allowed revascularization of three regions (the MCA territory unilaterally and the frontal areas bilaterally) and may serve as an alternative and safe treatment option for pediatric moyamoya patients. Originally published at: Esposito, Giuseppe; Kronenburg, Annick; Fierstra, Jorn; Braun, Kees P J; Klijn, Catharina J M; van der Zwan, Albert; Regli, Luca (2015). "STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis" as a one-staged revascularization strategy for pediatric moyamoya vasculopathy. Child's Nervous System, 31 (5) hypoperfusion. The middle cerebral artery (MCA) territory and the bifrontal areas are the regions most frequently affected. Although most techniques aim to only revascularize the MCA territory, augmentation of blood flow of the bifrontal areas is of importance in the pediatric moyamoya population since these regions play an important role in cognition, intellectual development, and in lower extremity and sphincter function. We recently described a one-staged surgical procedure combining revascularization of three regions, the MCA territory unilaterally and the frontal areas bilaterally. The purpose of this article is to report our surgical experience in e...

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“…14 Moyamoya disease is a unique cerebrovascular disease in that revascularization surgery can effectively prevent ischemic events and thus improve the longterm clinical outcome. 15,16 Neurologic deficit and transient ischemic attacks are expected to be abolished, cognitive developments is expected to be normalized, and intelligence is expected to be improved after successful bypass surgery. [15][16][17] This can happen because successful revascularization surgery is accompanied by catch-up growth and functioning of brain with normalized perfusion with ample perfusion reserve.…”

Section: Discussionmentioning

confidence: 99%

“…14 Revascularization surgery was found to prevent this deterioration of intellectual functions by improving the cerebral blood flow. 16,17 A subgroup of 21 patients performed preoperative and postoperative intelli- Figure 2. Case with preserved rCVR on postoperative SPECT and excellent clinical outcome at 44 months after operation (36 months after SPECT).…”

Section: So Et Al Outcome Of Moyamoya Disease By Spectmentioning

confidence: 99%

Prediction of the Clinical Outcome of Pediatric Moyamoya Disease With Postoperative Basal/Acetazolamide Stress Brain Perfusion SPECT After Revascularization Surgery

Lee

Kim

et al. 2005

Stroke

109

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Background and Purpose-We evaluated whether basal/acetazolamide stress brain perfusion SPECT performed after revascularization surgery can predict the further clinical outcome of patients with pediatric moyamoya disease. Methods-A total of 77 (31 males, 46 females, age 6.6Ϯ3.2 years) patients with postoperative pediatric moyamoya disease who underwent basal/acetazolamide stress brain perfusion SPECT 6 to 12 months after revascularization surgery and who were followed-up Ͼ12 months after SPECT were included. Mean follow-up period after SPECT was 36Ϯ19 months. Sixty-two patients underwent bilateral ribbon encephaloduroarteriosynangiosis (EDAS), 14 bilateral EDAS, and 1 unilateral EDAS. Ordinal logistic regression analysis using 5 independent variables (infarction on preoperative MRI, age at the first operation, highest Suzuki stage on cerebral angiography, and regional cerebrovascular reserve on postoperative SPECT) against postoperative clinical outcomes was performed. Results-Fifty-one patients had preserved reserve on postoperative SPECT and their clinical outcomes were excellent (30), good (15), fair (4), and poor (2); 26 patients had decreased reserve (excellent, 1; good, 7; fair, 14; poor, 4). On ordinal logistic regression analysis, age at the first operation (Pϭ0.033) and reserve on postoperative SPECT (PϽ0.001) were statistically significant. Conclusion-Basal/acetazolamide stress brain perfusion SPECT performed at 6 to 12 months after the indirect bypass operation could predict the further clinical outcome of pediatric patients with moyamoya disease. Patients with decreased cerebrovascular reserve will have remaining neurological deficit and ischemic attacks on follow-up. (Stroke.

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Intelligence in children with moyamoya disease: evaluation after surgical treatments with special reference to changes in cerebral blood flow.

Cited by 61 publications

References 15 publications

Clinical Features of Moyamoya Disease in the United States

Clinical Features of Moyamoya Disease in the United States

“STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis” as a one-staged revascularization strategy for pediatric moyamoya vasculopathy

Prediction of the Clinical Outcome of Pediatric Moyamoya Disease With Postoperative Basal/Acetazolamide Stress Brain Perfusion SPECT After Revascularization Surgery

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