Indirect bypass for maternal symptomatic moyamoya in the first trimester of pregnancy: case report

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There are no practice guidelines for the treatment of moyamoya disease in pregnant women. The need for such guidelines, however, is evidenced by the numerous case reports, case series, and systematic reviews in the literature highlighting an at-risk period for female moyamoya patients of childbearing age. Here the authors review and interpret the existing literature as it applies to their index patient and expand the literature in support of treating select patients during pregnancy. The authors describe what is to their knowledge the first case reported in the literature of a patient successfully treated with indirect surgical revascularization during the first trimester, who went on to deliver a healthy term baby without complications.

ABBREVIATIONS ICA = internal carotid artery; PHACES = Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac anomalies, Eye anomalies, and Sternal cleft and supraumbilical raphe; TIA = transient ischemic attack.
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Contributor Notes

Correspondence Katie P. Fehnel: Boston Children’s Hospital, Boston, MA. katie.fehnel@childrens.harvard.edu.INCLUDE WHEN CITING Published online November 22, 2019; DOI: 10.3171/2019.9.PEDS19360.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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