Multiple bur hole surgery for the treatment of moyamoya disease in children

Sainte‐Rose, Christian; Oliveira, Ricardo; Puget, Stéphanie; Beni‐Adani, Liana; Boddaert, Nathalie; Thorne, John; Wray, Alison; Zérah, Michel; Bourgeois, Marie

doi:10.3171/ped.2006.105.6.437

Cited by 46 publications

(51 citation statements)

References 18 publications

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“…8 Briefly, a uni-or bilateral coronal incision with subgaleal dissection exposes the skull vault. Between 15 and 20 burr-holes are drilled according to the following technique: A triangular periosteal flap is elevated, a Ͻ1 cm burr-hole is drilled, and the dura and arachnoid layers are opened.…”

Section: Surgical Techniquementioning

confidence: 99%

Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI

Blauwblomme

Lemaître

Naggara

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The severity of Moyamoya disease is generally scaled with conventional angiography and nuclear medicine. Arterial spin-labeling MR imaging is now acknowledged for the noninvasive quantification of cerebral blood flow. This study aimed to analyze CBF modifications with statistical parametric mapping of arterial spin-labeling MR imaging in children undergoing an operation for Moyamoya disease.

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Section: Surgical Techniquementioning

confidence: 99%

Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI

Blauwblomme

Lemaître

Naggara

et al. 2015

AJNR Am J Neuroradiol

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“…40 This technique was developed after vasculogenesis was observed in patients with ventriculostomies requiring cranial bur holes. Thus, strategically placed bur holes in areas of cerebral hypoperfusion might aid in stimulating vascular formation between underlying cortex and dura mater, effectively providing an arterial supply to hypoxic areas of the brain.…”

Section: Neurosurg Focus / Volume 24 / February 2008mentioning

confidence: 99%

“…Another technique that has not been widely applied is the sole use of multiple cranial bur holes. In a study by Sainte-Rose et al, 40 14 children received 10-24 bur holes in the frontotemporoparietooccipital area of each hemisphere. These authors reported complete resolution of ischemic episodes and motor improvement in those with preoperative paresis.…”

Section: Neurosurg Focus / Volume 24 / February 2008mentioning

confidence: 99%

“…In the Scott and colleagues' 45 study of 143 pediatric patients with MMD in North America, nearly all of the patients presented with symptoms of either stroke or TIA; similar findings were revealed in European studies. 18,40 Moreover, in large populations of Asian patients, ~ 40% of those younger than 10 years of age presented with a TIA and nearly 30% presented with cerebral infarction; 23 some presented with headaches and seizures. Note, however, that adults most commonly present with cerebral hemorrhage.…”

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confidence: 99%

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Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

Veeravagu¹,

Guzman²,

Patil³

et al. 2008

FOC

117

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✓Neurosurgical interventions for moyamoya disease (MMD) in pediatric patients include direct, indirect, and combined revascularization procedures. Each technique has shown efficacy in the treatment of pediatric MMD; however, no single study has demonstrated the superiority of one technique over another. In this review, the authors explore the various studies focused on the use of these techniques for MMD in the pediatric population. They summarize the results of each study to clearly depict the clinical outcomes achieved at each institution that had utilized direct, indirect, or combined techniques. In certain studies, multiple techniques were used, and the clinical or radiological outcomes were compared accordingly. Direct techniques have been shown to aid a reduction in perioperative strokes and provide immediate revascularization to ischemic areas; however, these procedures are technically challenging, and not all pediatric patients are appropriate candidates. Indirect techniques have also shown efficacy in the pediatric population but may require a longer period for revascularization to occur and perfusion deficits to be reversed. The authors concluded that the clinical efficacy of one technique over another is still unclear, as most studies have had small populations and the same outcome measures have not been applied. Authors who compared direct and indirect techniques noted approximately equal clinical outcomes with differences in radiological findings. Additional, larger studies are needed to determine the advantages and disadvantages of the different techniques for the pediatric age group.

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“…EMS and EDAS are the two principal procedures for single indirect bypass and have spurred the development of a multitude of variants that have used the scalp arteries, galea, dura mater, muscles, and omentum as donor tissues. 15,17,21,40,59) Endo et al, 2) Kawaguchi et al, 19) and Seinte-Rose et al 52) even reported a multiple burr hole surgery technique for children with moyamoya disease.…”

mentioning

confidence: 99%

History of the Development of Surgical Treatments for Moyamoya Disease

Matsushima

Inoue

Kawashima

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Many surgical treatments for moyamoya disease have been developed over the past 40 years. The optimum treatment for ischemic-type moyamoya disease is almost established. The first surgical treatment for the disease was the superficial temporal artery to middle carotid artery (STA-MCA) anastomosis. The discovery of spontaneous collateral formation following the STA-MCA anastomosis surgery led to the development of various indirect bypass procedures. Collateral formation and clinical outcomes from direct and indirect procedures have been compared to assess the merits and limitations of each technique. Experience and a greater understanding of the surgical effects of moyamoya disease have led to the development of surgical procedures combining various direct and indirect bypass techniques for optimal restoration of perfusion. This review of the historical development and efficacy of each procedure will aid surgeons in selecting the most appropriate surgical procedure for patients of different ages with different symptoms and disease severities.

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Multiple bur hole surgery for the treatment of moyamoya disease in children

Abstract: The results obtained in this series suggest that in children with moyamoya disease this simple technique is both effective and safe. Furthermore, it is effective as a sole treatment without supplementary revascularization procedures.

Cited by 46 publications

References 18 publications

Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI

Cerebral Blood Flow Improvement after Indirect Revascularization for Pediatric Moyamoya Disease: A Statistical Analysis of Arterial Spin-Labeling MRI

Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

History of the Development of Surgical Treatments for Moyamoya Disease

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