Clinical outcomes after revascularization for pediatric moyamoya disease and syndrome: A single-center series
Document Type
Article
Abstract
Moyamoya is a progressive cerebrovascular arteriopathy that affects children of any age. The goal of this study was to determine imaging and clinical outcomes as well as complication rates in a pediatric cohort undergoing either a combined direct/indirect or indirect-only revascularization approach. Patients with moyamoya disease or syndrome ≤ 18 years of age at the time of initial surgery were identified, and clinical data were collected retrospectively. Over a 12-year period, 26 patients underwent revascularization procedures on 49 hemispheres with a median follow-up of 2.6 years from surgery. Median age at surgery was 7.3 years (range 1.4–18.0 years). Thirty-three hemispheres (67.3%) underwent combined revascularization with a direct bypass and encephalomyosynangiosis, and sixteen hemispheres (32.7%) underwent indirect-only revascularization. The rate of 30-day perioperative complication was 10.2%, and the rate of postoperative clinical stroke by end of follow-up was 10.2% by hemisphere. There was a 5.7% rate of intraoperative bypass failure requiring conversion to an indirect revascularization approach. On follow-up imaging, 96.9% of direct bypasses remained patent. On multivariate analysis, higher preoperative Pediatric Stroke Outcome Measure (PSOM) scores were associated with lower rates of good clinical outcome on follow-up (unit OR 0.03; p = 0.03). Patients with age < 5.4 years had lower rates of good clinical outcome on follow-up. In this North American cohort, both combined direct/indirect and indirect only revascularization techniques were feasible. However, younger children < 5.4 years of age have worse outcomes than older children, similar to east Asian cohorts.
Publication Date
9-1-2020
Publication Title
Journal of Clinical Neuroscience
ISSN
09675868
E-ISSN
15322653
Volume
79
First Page
137
Last Page
143
PubMed ID
33070883
Digital Object Identifier (DOI)
10.1016/j.jocn.2020.07.016
Recommended Citation
Morshed, Ramin A.; Abla, Adib A.; Murph, Daniel; Dao, Jasmin M.; Winkler, Ethan A.; Burkhardt, Jan Karl; Colao, Kathleen; Hetts, Steven W.; Fullerton, Heather J.; Lawton, Michael T.; Gupta, Nalin; and Fox, Christine K., "Clinical outcomes after revascularization for pediatric moyamoya disease and syndrome: A single-center series" (2020). Neurosurgery. 1394.
https://scholar.barrowneuro.org/neurosurgery/1394