Neurologic complications of cerebral angiography in childhood moyamoya syndrome

Abstract

Purpose. To determine the incidence of neurologic complications of cerebral angiography in children with moyamoya syndrome (MMS) as compared to children without MMS. Materials and methods. One-hundred-ninety consecutive cerebral angiograms obtained in 152 children were evaluated. Sixty of these angiograms were obtained in 40 children with MMS. Patients underwent neurologic evaluation prior to and after the procedure. For this study, a neurologic complication was defined as any new focal neurologic deficit or alteration in mental status occurring during the procedure or within the ensuing 24 hours. Results. There were 2 neurologic complications within 24 hours of angiography, one in the MMS group and one in the non-MMS group. One patient with MMS became mute following angiography. The symptom resolved within 12 hours. One patient without MMS being examined postoperatively for residual arteriovenous malformation developed intracranial hemorrhage requiring reexploration 12 hours after the angiogram. Using a two-tail Fisher's exact test, there was no significant statistical difference in the ischemic (P = 0.3) or hemorrhagic (P = 1.0) complication rates between the group of patients with MMS and the non-MMS groups. Conclusion. The risk of a neurologic complication from cerebral angiography in children with MMS is low and not statistically different from the risk in children with other cerebrovascular disorders.

Management of Stroke in Infants and Children

“…In a study of 190 angiograms from pediatric patients, the complication rate from angiography in children with moyamoya syndrome was no higher than the risk of angiography in nonmoyamoya populations with other forms of cerebrovascular disease. 154 Techniques such as TCD, perfusion CT, xenon-enhanced CT, positron emission tomography (PET), MR perfusion imaging, [155][156][157] and single-photon emission CT (SPECT) with acetazolamide challenge have been used to evaluate moyamoya syndrome. TCD provides a noninvasive way to follow changes in blood flow velocities in larger cerebral vessels over time, whereas xenon-enhanced CT, PET, and SPECT can detect inadequate resting perfusion and poor blood flow reserve before treatment and can help determine the extent of the improvement in functional perfusion after therapy.…”

Vascular Anomalies in Pediatrics

“…The acronym PHACE refers to posterior fossa abnormalities, hemangiomas, arterial cerebrovascular anomalies (eg, aneurysm, occlusion, stenosis, or persistent intra-and extracranial embryonic arteries), cardiac defects (eg, aortic coarctation or right-sided aortic arch), and eye abnormalities (eg, microphthalmia, cogenital cataract, or optic nerve hypoplasia). PHACES is the appropriate term when ventral defects, such as sternal clefting or supraumbilical raphe, are present [18][19][20]. More girls are affected with PHACE association, as high as 9:1, compared with 3:1 in IH [21].…”

Intracranial Cerebrovascular Occlusive Disease

“…Angiography in children with moyamoya disease is not associated with a higher rate of complications compared with angiography in children without moyamoya. 76 Angiography is the best imaging technique to distinguish high-grade stenosis from occlusion, identify intracranial aneurysms, and assess collateral circulation. Importantly, angiography is critical for planning surgical procedures; for instance, angiography can best demonstrate transdural collateral vessels that should be preserved during revascularization procedures.…”