title: Indications for one-stage extensive indirect vascular reconstructive surgery for pediatric moyamoya disease: 4 case reports.
abstract: BACKGROUND
  Many modified surgical techniques for moyamoya disease have been developed, and each of which has some advantages and disadvantages. We report the indication for one-stage extensive indirect vascular reconstructive surgery that is our original technique for pediatric moyamoya disease.
  
  
  METHODS
  Case 1 was a 3-year-old boy who had TIAs involving the bilateral extremities and provoked by intense crying. Case 2 was a 5-year-old girl who had TIAs involving the right extremities and provoked by intense crying. Case 3 was an 8-year-old girl who had frequent TIAs involving the bilateral extremities. Case 4 was a 3-year-old boy who had mild tetraplegia due to bilateral cerebral infarction. In all cases but case 4, preoperative investigations demonstrated same-stage moyamoya disease. In case 4, preoperative investigations demonstrated different-stage moyamoya disease in which acute progression of bilateral major arterial stenosis occurred. Hence, all patients underwent one-stage extensive indirect vascular reconstructive surgery of the bilateral cerebral hemispheres. Postoperative investigations revealed the development of rich neovascularization, disappearance of clinical symptoms in all cases.
  
  
  CONCLUSIONS
  We recommend one-stage extensive indirect vascular reconstructive surgery for pediatric moyamoya disease, particularly for patients younger than 5 years, when preoperative investigations reveal a same-stage case or bilateral acute progressive case.
authors.affiliation: Department of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama-shi, Ehime, Japan. hiroaki-matsu@umin.ac.jp
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kanehisa
authors.initials: K
authors.lastname: Kohno