title: Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease.
abstract: OBJECTIVE
  In the study of pediatric moyamoya disease, information on long-term social outcomes and risk factors for unfavorable social outcomes remains insufficient. The authors analyzed the long-term results of surgical revascularization for pediatric patients with moyamoya disease to determine whether the involvement of a stenoocclusive lesion in the posterior cerebral artery (PCA), relatively common in pediatric moyamoya disease, represents an underlying predictor for unfavorable social outcomes.
  
  
  METHODS
  Prospectively collected data on 61 consecutive patients with moyamoya disease who had undergone combined bypass surgery were analyzed. Neuroradiological features and other baseline clinical factors were incorporated into univariate and multivariate analyses to determine any association with an unfavorable social outcome, defined as difficulty attending regular school or obtaining regular employment.
  
  
  RESULTS
  Posterior cerebral artery involvement detected by angiography on admission was noted in 22 (36.1%) of the 61 patients. Follow-up data were acquired in 56 patients (91.8%), and the mean follow-up period was 15.8 years. While transient ischemic attacks were eliminated in 52 (92.9%) of these 56 patients after surgery, and late-onset ischemic stroke was observed in only 1 patient during the follow-up period, 10 (17.9%) experienced an unfavorable social outcome. Although younger age at onset, longer duration between onset and surgery, infarction present on preoperative neuroradiological images, and PCA involvement had been identified as risk factors for an unfavorable social outcome in univariate analysis, only infarction present on preoperative images and PCA involvement remained statistically significant after multivariate adjustment.
  
  
  CONCLUSIONS
  Posterior cerebral artery involvement can be considered one of the underlying risk factors for unfavorable social outcome and should be studied further to improve social outcome in pediatric moyamoya disease.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto;
authors.forename: Takeshi
authors.initials: T
authors.lastname: Funaki
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Araki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Kataoka
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002648:Child; D002675:Child, Preschool; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control; D007564:Japan; D008297:Male; D009072:Moyamoya Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020769:Posterior Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D013334:Students; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult