Relative contributions of the middle meningeal artery and superficial temporal artery in revascularization surgery for moyamoya syndrome in children: the results of superselective angiography

Clinical article

Restricted access

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Object

The authors used postoperative superselective angiography to assess the relative contributions of the middle meningeal artery (MMA) and the superficial temporal artery (STA) to revascularization following surgery for moyamoya syndrome in children.

Methods

Using the neurosurgical database at the Hospital for Sick Children, the authors reviewed the clinical and pre- and postoperative angiographic records obtained in patients with moyamoya syndrome undergoing superselective angiography. Patients were 16 years of age or younger and were undergoing revascularization surgery for moyamoya syndrome during the study period. Lateral internal carotid artery, external carotid artery, STA, and MMA angiograms were analyzed in the late arterial phase to assess the relative contributions of the STA and MMA to overall revascularization as determined by the external carotid artery injection.

Results

The total moyamoya surgical revascularization experience at the Hospital for Sick Children over a 12-year period (May 1996–December 2008) comprised 33 patients (20 girls and 13 boys) undergoing a total of 50 craniotomies. A decision was made in 2001 to perform superselective angiography postoperatively in patients with moyamoya syndrome. Superselective angiography was identified to have been performed postoperatively in 12 patients and 18 treated hemispheres, and it demonstrated that the MMA contributed more significantly than the STA in 11 (61%) of the 18 hemispheres.

Seven patients were Asian, 3 patients had neurofibromatosis Type 1, 1 had Down syndrome, and 2 had no apparent risk factors (1 patient was Asian and had neurofibromatosis Type 1). Stroke had occurred in 58% of patients and transient ischemic attacks in 50% prior to surgery. Within the first 30 days of surgery, there were 2 episodes of stroke (11.7% per surgically treated hemisphere and 18.2% per patient). Seventy-eight percent of hemispheres surgically treated exhibited excellent revascularization (Matsushima Grade A) on follow-up angiography, and there were no strokes documented in any patients more than 1 month after surgery, in a long-term follow-up of mean 4.1 years.

Conclusions

The contributions of the MMA to revascularization after pial synangiosis for moyamoya syndrome are significant and may frequently exceed the contribution of the STA when surgery is performed with preservation of dural vasculature and dural inversion.

Abbreviations used in this paper:ECA = external carotid artery; ICA = internal carotid artery; MCA = middle cerebral artery; MMA = middle meningeal artery; NF1 = neurofibromatosis Type 1; STA = superficial temporal artery; TIA = transient ischemic attack.
Article Information

Contributor Notes

Address correspondence to: Peter B. Dirks, M.D., Ph.D., Hospital for Sick Children, Suite 1503, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. email: peter.dirks@sickkids.ca.
Headings
References
  • 1

    Dauser RCTuite GFMcCluggage CW: Dural inversion procedure for moyamoya disease. Technical note. J Neurosurg 86:7197231997

  • 2

    Djindjian R: Super-selective arteriography of branches of the external carotid artery. Surg Neurol 5:1331421976

  • 3

    Endo MKawano NMiyaska YYada K: Cranial burr hole for revascularization in moyamoya disease. J Neurosurg 71:1801851989

  • 4

    Kashiwagi SKato SYamashita KTakasago TAkimura TOkamura S: Revascularization with split duro-encephalo-synangiosis in the pediatric moyamoya disease—surgical result and clinical outcome. Clin Neurol Neurosurg 99:Suppl 2S115S1171997

    • Search Google Scholar
    • Export Citation
  • 5

    Kashiwagi SKato SYasuhara SWakuta YYamashita TIto H: Use of a split dura for revascularization of ischemic hemispheres in moyamoya disease. J Neurosurg 85:3803831996

    • Search Google Scholar
    • Export Citation
  • 6

    Matsushima TInoue TSuzuki SOFujii KFukui MHasuo K: Surgical treatment of moyamoya disease in pediatric patients—comparison between the results of indirect and direct revascularization procedures. Neurosurgery 31:4014051992

    • Search Google Scholar
    • Export Citation
  • 7

    Miyamoto SAkiyama YNagata IKarasawa JNozaki KHashimoto N: Long-term outcome after STA-MCA anastomosis for moyamoya disease. Neurosurg Focus 5:5e51998

    • Search Google Scholar
    • Export Citation
  • 8

    Miyamoto SNagata IHashimoto NKikuchi H: Direct anastomotic bypass for cerebrovascular moyamoya disease. Neurol Med Chir (Tokyo) 38:Suppl2942961998

    • Search Google Scholar
    • Export Citation
  • 9

    Nagaraja DVerma ATaly ABKumar MVJayakumar PN: Cerebrovascular disease in children. Acta Neurol Scand 90:2512551994

  • 10

    Sainte-Rose COliveira RPuget SBeni-Adani LBoddaert NThorne J: Multiple bur hole surgery for the treatment of moyamoya disease in children. J Neurosurg 105:6 Suppl4374432006

    • Search Google Scholar
    • Export Citation
  • 11

    Scott RMSmith JLRobertson RLMadsen JRSoriano SGRockoff MA: Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg 100:2 Suppl Pediatrics1421492004

    • Search Google Scholar
    • Export Citation
  • 12

    Suzuki JKodama N: Moyamoya disease—a review. Stroke 14:1041091983

  • 13

    Suzuki JKodama NTakaku A: [Diseases showing abnormal vascular network at the base of brain, commonly found among Japanese (Cerebrovascular “Moyamoya” disease). 5. “Ethmoidal Moyamoya.”]. No To Shinkei 22:4174241970. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 14

    Suzuki JTakaku A: Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:2882991969

    • Search Google Scholar
    • Export Citation
  • 15

    Veeravagu AGuzman RPatil CGHou LCLee MSteinberg GK: Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions. Neurosurg Focus 24:2E162008

    • Search Google Scholar
    • Export Citation
  • 16

    Zipfel GJFox DJ JrRivet DJ: Moyamoya disease in adults: the role of cerebral revascularization. Skull Base 15:27412005

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 342 292 20
Full Text Views 141 13 1
PDF Downloads 83 9 3
EPUB Downloads 0 0 0
PubMed
Google Scholar