title: Combined encephaloduroarteriosynangiosis and bifrontal encephalogaleo(periosteal)synangiosis in pediatric moyamoya disease.
abstract: OBJECTIVE
  We compared the surgical results of simple encephaloduroarteriosynangiosis (EDAS) and EDAS with bifrontal encephalogaleo(periosteal)synangiosis for the treatment of pediatric moyamoya disease.
  
  
  METHODS
  Data for 159 children (up to 15 yr of age, 76 boys and 83 girls) who underwent indirect revascularization procedures for the treatment of moyamoya disease between 1987 and 1998 were retrospectively reviewed. Group A patients underwent simple EDAS (n = 67). Group B patients underwent EDAS with bifrontal encephalogaleo(periosteal)synangiosis (n = 92). The surgical results for each group were compared, in terms of clinical outcomes, neuroimaging changes, extent of revascularization evident on angiograms, and hemodynamic changes evident on single-photon emission computed tomographic scans. The average follow-up periods were 45 months for Group A and 22 months for Group B.
  
  
  RESULTS
  The overall clinical outcomes and neuroimaging changes tended to be better for Group B. In terms of single-photon emission computed tomographic changes of the whole brain after surgery, Group B patients exhibited more favorable outcomes than did Group A patients (62 versus 36%, P = 0.003). The surgical results for the anterior cerebral artery territory were significantly better for Group B than for Group A, with respect to outcomes of anterior cerebral artery symptoms (81 versus 40%, P = 0.015), revascularization on angiograms (79 versus 16%, P < 0.001), and hemodynamic changes on single-photon emission computed tomographic scans (70 versus 52%, P = 0.002). The incidences of postoperative infarctions were not significantly different between the two groups.
  
  
  CONCLUSIONS
  EDAS with bifrontal encephalogaleo(periosteal)synangiosis is a more effective surgical modality for the treatment of pediatric moyamoya disease, compared with simple EDAS, because it covers both the middle cerebral artery and anterior cerebral artery territories of the brain.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Kyu-Chang
authors.initials: KC
authors.lastname: Wang
authors.forename: In-One
authors.initials: IO
authors.lastname: Kim
authors.forename: Dong Soo
authors.initials: DS
authors.lastname: Lee
authors.forename: Byung-Kyu
authors.initials: BK
authors.lastname: Cho
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003097:Collateral Circulation / Q000502:physiology; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D005625:Frontal Lobe / Q000098:blood supply*; D006801:Humans; D007223:Infant; D020243:Infarction, Anterior Cerebral Artery / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D007360:Intelligence / Q000502:physiology; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009072:Moyamoya Disease / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D012039:Regional Blood Flow / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome