Direct extracranial-intracranial bypass for children with moyamoya disease.
To improve cerebral hypoperfusion in the ischemic type of Moyamoya disease, we have applied superficial temporal artery-middle cerebral artery (STA-MCA) double anastomoses in combination with encephalo-myo-synangiosis (EMS) for 19 hemispheres of 10 children (age from 5 to 11 years at surgery). Two branches of the STA were anastomosed to the two cortical arteries which were selected in the watershed area of the cerebral hemisphere estimated as a hypoperfusion area on the preoperative angiograms. Before surgery transient ischemic attacks (TIAs) developed from every month to every 6 months in association with hyperventilation or sobbing. No perioperative completed stroke or wound complications was observed, although single TIA developed in four patients within 1 month after surgery. Postoperative angiogram demonstrated that, not only the preoperative watershed area, but also the most of the middle cerebral artery territory was oppacified via the 2 branches of the STA in all 19 hemispheres. In a mean follow-up period of 4 years, no ischemic episode was induced by hyperventilation, and there was no mental or neurological deterioration. STA-MCA double anastomoses, to the cerebral watershed area, in combination with EMS are safe and effective even for younger children with Moyamoya disease.
Sakamoto
H
H
Department of Pediatric Neurosurgery, Oaska City General Hospital, Japan.
Kitano
S
S
Yasui
T
T
Komiyama
M
M
Nishikawa
M
M
Iwai
Y
Y
Yamanaka
K
K
Nakajima
H
H
Kishi
H
H
Kan
M
M
Fujitani
K
K
Hakuba
A
A
D000714:Anastomosis, Surgical; D002342:Carotid Artery, External / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000601:surgery*; D002548:Cerebral Revascularization; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000601:surgery*