title: Angiographic changes after pial synangiosis in childhood moyamoya disease.
abstract: OBJECTIVE
  To describe the angiographic changes accompanying the surgical treatment of moyamoya disease by pial synangiosis and to compare these changes with patient outcome.
  
  
  METHODS
  The preoperative and postoperative cerebral angiograms, MR images, and clinical records of 13 children treated with pial synangiosis for moyamoya disease were reviewed.
  
  
  RESULTS
  After synangiosis, 10 patients had significant neurologic improvement and three had minimal or no improvement. Postoperative MR images showed no new infarctions. Well-developed (grade A or B) transpial or transdural collaterals to the brain were present at the site of synangiosis in 84% of the surgically treated hemispheres. Cerebrovascular occlusive changes increased postoperatively in 76% of hemispheres. After synangiosis, moyamoya collaterals were increased in 48%, unchanged in 16%, and decreased in 36% of surgically treated hemispheres. All 10 patients with grade A or B collaterals bilaterally after synangiosis were asymptomatic or improved on follow-up.
  
  
  CONCLUSIONS
  Pial synangiosis typically results in an increase in collaterals from the superficial temporal artery or middle meningeal artery to the brain. Synangiosis appears to result in stabilization or improvement in neurologic symptoms but does not prevent the angiographic progression of disease or the development of moyamoya collaterals. The angiographic demonstration of well-formed collaterals after synangiosis is associated with a favorable clinical outcome.
authors.affiliation: Department of Radiology, Children's Hospital Medical Center and Harvard Medical School, Boston, Mass. 02115, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Robertson
authors.forename: P E
authors.initials: PE
authors.lastname: Burrows
authors.forename: P D
authors.initials: PD
authors.lastname: Barnes
authors.forename: C D
authors.initials: CD
authors.lastname: Robson
authors.forename: T Y
authors.initials: TY
authors.lastname: Poussaint
authors.forename: R M
authors.initials: RM
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation / Q000502:physiology; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D010841:Pia Mater / Q000098:blood supply* / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis