title: Effective surgical revascularization improves cerebral hemodynamics and resolves headache in pediatric Moyamoya disease.
abstract: BACKGROUND
  Headache is one of the major clinical presentations in pediatric Moyamoya disease. However, the clinical features and underlying mechanisms are not fully understood. This study aimed to clarify the clinical feature of headache in pediatric Moyamoya disease and the effect of surgical revascularization.
  
  
  METHODS
  This study included 29 pediatric patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass for Moyamoya disease. Their medical records were precisely evaluated to identify the clinical features of their headache. The findings on magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography also were analyzed.
  
  
  RESULTS
  Preoperative headache was documented in 11 (38%) of 29 patients. The majority of them complained of severe headache in the frontal or temporal region in the morning. Headache was significantly related to more advanced disease stage and to the decreases in cerebral blood flow and its reactivity to acetazolamide. Surgical revascularization completely resolved headache in all 11 patients.
  
  
  CONCLUSIONS
  These findings strongly suggest that disturbed cerebral hemodynamics may play key roles in developing severe headache in pediatric Moyamoya disease. STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis may be effective procedures to rapidly resolve headache by widely supplying collateral blood flow to the operated hemispheres.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Kawabori
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirata
authors.forename: Toru
authors.initials: T
authors.lastname: Shiga
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
authors.forename: Nagara
authors.initials: N
authors.lastname: Tamaki
mesh_terms: D000293:Adolescent; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D049268:Positron-Emission Tomography; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon