Pediatric moyamoya disease: An analysis of 410 consecutive cases

Abstract

Our results indicate that an early diagnosis and active intervention before establishment of irreversible hemodynamic change are essential to achieve a favorable clinical outcome in children with MMD.

Quantitative Assessment of Neovascularization after Indirect Bypass Surgery: Color-Coded Digital Subtraction Angiography in Pediatric Moyamoya Disease

“…Noninvasive imaging modalities such as perfusion MR imaging, single-photon emission CT, and positron-emission tomography can demonstrate secondary hemodynamic changes. [1][2][3][4]12,[21][22][23][24][25][26][27] However, these methods show only overall cerebral perfusion changes and cannot directly visualize fine parenchymal neovascularization itself following the operation.…”

“…[1][2][3][4] Surgical neovascularization is considered the most successful means of improving cerebral hemodynamics and resolving clinical symptoms. 1,2,[4][5][6][7] These surgical procedures can be categorized into 3 types: direct, indirect, or combined bypass. 1,2,5-9 Indirect bypass surgery using the parietal branch of the superficial temporal artery, encephaloduroarteriosynangiosis (EDAS), is preferred in pediatric patients with MMD because of the simple technique and the lower risk of temporary ischemia during the operation.…”

Combined Bypass Technique for Contemporary Revascularization of Unilateral MCA and Bilateral Frontal Territories in Moyamoya Vasculopathy

“…It represents a good alternative to the existing techniques for frontal territories revascularization such as the technically challenging direct STA-ACA bypass or other procedures that need exposure of the interhemispheric fissure (IF). [10][11][12][13]. In fact, the use of separate frontal parasagittal craniotomies, located one on the left-and one the right-side 2 cm away from the midline, reduces the risk of injuries to the SSS and the parasagittal veins.…”

“…However, revascularization in the frontal territory is receiving gradually more attention: a considerable part of the ischemic presentation of (pediatric) moyamoya patients consists of neurocognitive disorders as well as lower extremity function, caused by frontal hypoperfusion. [2,5,12,24] Re-establishing cerebral blood flow (CBF) in the frontal territory may prevent, stabilize or improve neurocognitive decline. [6][7]15,[17][18][19][20]24] In this paper, we describe a combined one-staged procedure for revascularization of the MCA territory unilaterally by a direct STA-MCA bypass and the bifrontal territory by an encephalo-duro-periosteal-synangiosis (EDPS).…”

Cognitive decline in moyamoya: influence of chronic cerebral hypoxia, history of stroke, or comorbid conditions?

“…Bilateral vasculopathy and duration of the disease are other important factors, suggested by the study by Williams et al 2 Even with these elements, choosing the right moment for surgery candidacy may be quite difficult and subjective. Because surgery increases cognitive abilities (or prevents further decline) and decreases stroke occurrence, 4,5 other quantitative tools are needed to evaluate the chronic effects of hypoxia. In this way, cognitive and behavioral aspects should be further studied using thorough longitudinal pre-and post-operative neuropsychological follow-up.…”