Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease

Clinical article

Takeshi Funaki M.D. 1 , Jun C. Takahashi M.D., Ph.D. 1 , Yasushi Takagi M.D., Ph.D. 1 , Kazumichi Yoshida M.D., Ph.D. 1 , Yoshio Araki M.D., Ph.D. 2 , Takayuki Kikuchi M.D., Ph.D. 1 , Hiroharu Kataoka M.D., Ph.D. 3 , Koji Iihara M.D., Ph.D. 3 , and Susumu Miyamoto M.D., Ph.D. 1
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  • 1 Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto;
  • 2 Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya; and
  • 3 Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan
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Object

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.

Abbreviations used in this paper:ACA = anterior cerebral artery; EMS = encephalomyosynangiosis; ICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale; PCA = posterior cerebral artery; STA = superficial temporal artery.

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Contributor Notes

Address correspondence to: Takeshi Funaki, M.D., Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan. email: tfunaki@kuhp.kyoto-u.ac.jp.

Please include this information when citing this paper: published online October 18, 2013; DOI: 10.3171/2013.9.PEDS13111.

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