Surgical treatment for paediatric patients with moyamoya disease by indirect revascularization procedures (EDAS, EMS, EMAS)

Abstract

Surgical results of paediatric patients with Moyamoya disease who were treated by indirect revascularization procedures are reported. Encephalo-duro-arterio-synangiosis (EDAS), encephalomyo-arterio-synangiosis (EMAS), and/or encephalo-myo-synangiosis (EMS) were performed on 47 sides of 29 children with Moyamoya disease. The results of those non-anastomotic EC-IC bypass procedures were evaluated clinically, angiographically, and by computed tomography (CT). Postoperative external carotid angiograms showed a good collateral formation through EDAS, EMAS, or EMS in about 70-80 percent of all surgically treated sides. The symptoms such as TIA, RIND, and/or involuntary movements disappeared in the cases with a good collateral formation but not in those with insufficient development of the collateral circulation. The indirect EC-IC bypass surgery seems effective for most of the children with Moyamoya disease who present with ischaemic signs.

Surgical outcomes following encephaloduroarteriosynangiosis in adult moyamoya disease associated with Type 2 diabetes

“…Our clinical outcomes were divided into 4 grades: 1) excellent, in which the preoperative symptoms had totally disappeared with no fixed neurological deficits; 2) good, in which the symptoms had markedly decreased but neurological deficits remained; 3) fair, in which the symptoms persisted though less frequently; and 4) poor, in which the preoperative status remained either unchanged or worsened or new symptoms appeared. 20,28 The modified Rankin Scale (mRS) was used to determine the neurological functional outcomes before and after operation.…”

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

“…20 After the operation, collateral vessels from the superficial temporal artery develop at the flap site, along with simultaneous and sequential progression of steno-occlusive changes of the ICA and disappearance or diminishing of Moyamoya vessels. 18,21 Hemodynamic changes after the operation might be difficult to understand; likewise, estimating postoperative neovascularization status is challenging.…”

“…Moreover, neovascularization after indirect bypass surgery was known to become well-developed after 3ϳ6 months postoperatively. 20,[28][29][30][31] There are several study limitations. In some cases, postoperative DSA data might not be enough to provide real hemo- dynamic status after neovascularization.…”

Long-term outcome after STA-MCA anastomosis for moyamoya disease

“…[7,8,10] Indirect bypass procedures such as encephaloduroarteriosynangiosis or EMS are commonly performed because of their technical ease, although several authors have described cases in which patients are refractory to indirect bypass surgery. [1,5,7,8,10] To perform a direct bypass, microvascular anastomosis between small-caliber (usually under 1 mm in diameter) fragile vessels is required. As mentioned previously, several problems remain unresolved.…”

“…Cerebral revascularization procedures have been reported to improve the compromised cerebral blood flow, to reduce ischemic attacks, and to produce sufficiently good long-term results in most cases. [3][4][5][6]9] However, several issues remain controversial. If properly treated in childhood, can hemorrhage be avoided when the patient matures?…”