Encephaloduroarteriosynangiosis with bifrontal encephalogaleo(periosteal)synangiosis in the pediatric moyamoya disease: the surgical technique and its outcomes.
METHODS
To increase the blood flow of the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) territories, we modified the "ribbon" procedure in combination with encephaloduroarteriosynangiosis (EDAS). This is referred to as "EDAS with bifrontal encephalogaleo(periosteal)synangiosis (EGS)." The surgical technique, clinical outcomes, complications, extent of revascularization, and changes in CBF in 67 pediatric MMD patients were retrospectively reviewed.


RESULTS
The excellent and good clinical recovery rates were 57% and 31%. The rate for complete disappearance of TIA was 63%. All the bifrontal EGS made abundant collateral vessels in the ACA territory. When the EDAS with bifrontal EGS was performed in the first operation, collaterals of EGS sites developed more on the contralateral side of the EDAS. The arachnoid opening of the medial frontal lobe in the EGS site had no effect on the results. There was a positive correlation between the clinical outcome and the extent of angiographic revascularization. Improvements in the CBF and the reserve in ACA territory were observed in 57%.


CONCLUSIONS
EDAS with bifrontal EGS resulted in excellent revascularization in both the MCA and ACA territories. The clinical and hemodynamic results were also excellent. This procedure may be an effective and safe surgical modality for the prevention of ischemia in the whole territory of the anterior circulation of the brain in pediatric MMD.
Division of Pediatric Neurosurgery, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
Chae-Yong
CY
Kim
Kyu-Chang
KC
Wang
Seung-Ki
SK
Kim
You-Nam
YN
Chung
Hee-Soo
HS
Kim
Byung-Kyu
BK
Cho
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; D006801:Humans; D007223:Infant; D020243:Infarction, Anterior Cerebral Artery / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000601:surgery; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000601:surgery; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000601:surgery; D011183:Postoperative Complications; D012039:Regional Blood Flow / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D016896:Treatment Outcome