Right frontotemporal craniotomy for ECA-to-MCA direct and indirect bypass and occipital artery indirect bypass to the posterior circulation: case report

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  • Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Moyamoya is an uncommon disease that presents with stenoocclusion of the major vasculature at the base of the brain and associated collateral vessel formation. Many pediatric patients with moyamoya present with transient ischemic attacks or complete occlusions. The authors report the case of a 9-year-old girl who presented with posterior fossa hemorrhage and was treated with an emergency suboccipital craniotomy for evacuation. After emergency surgery, an angiogram was performed, and the patient was diagnosed with moyamoya disease. Six months later, the patient was treated for moyamoya using direct and indirect revascularization; after surgery there was excellent vascularization in both regions of the bypass and no further progression of moyamoya changes. This case illustrates a rare example of intracerebral hemorrhage associated with moyamoya changes in the posterior vascularization in a pediatric patient and subsequent use of direct and indirect revascularization to reduce the risk of future hemorrhage and moyamoya progression.

ABBREVIATIONS BA = basilar artery; CTA = CT angiography; ECA = external carotid artery; ICA = internal carotid artery; MCA = middle cerebral artery; STA = superficial temporal artery.

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Contributor Notes

Correspondence William T. Couldwell: University of Utah, Salt Lake City, UT. neuropub@hsc.utah.edu.

INCLUDE WHEN CITING Published online November 20, 2020; DOI: 10.3171/2020.7.PEDS20181.

Disclosures Dr. Taussky reports being a consultant to Medtronic, Stryker, and Cerenovus.

  • 1

    Suzuki J, Takaku A. Cerebrovascular “moyamoya” disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288299.

    • Search Google Scholar
    • Export Citation
  • 2

    Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009;360(12):12261237.

  • 3

    Baba T, Houkin K, Kuroda S. Novel epidemiological features of moyamoya disease. J Neurol Neurosurg Psychiatry. 2008;79(8):900904.

  • 4

    Appireddy R, Ranjan M, Durafourt BA, Surgery for moyamoya disease in children. J Child Neurol. 2019;34(9):517529.

  • 5

    Kim SK, Cho BK, Phi JH, Pediatric moyamoya disease: an analysis of 410 consecutive cases. Ann Neurol. 2010;68(1):92101.

  • 6

    Kim JS. Moyamoya disease: epidemiology, clinical features, and diagnosis. J Stroke. 2016;18(1):211.

  • 7

    Mugikura S, Higano S, Shirane R, Posterior circulation and high prevalence of ischemic stroke among young pediatric patients with moyamoya disease: evidence of angiography-based differences by age at diagnosis. AJNR Am J Neuroradiol. 2011;32(1):192198.

    • Search Google Scholar
    • Export Citation
  • 8

    Hishikawa T, Tokunaga K, Sugiu K, Date I. Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease. J Neurosurg. 2013;119(4):961965.

    • Search Google Scholar
    • Export Citation
  • 9

    Lee JY, Kim SK, Phi JH, Wang KC. Posterior cerebral artery insufficiency in pediatric moyamoya disease. J Korean Neurosurg Soc. 2015;57(6):436439.

    • Search Google Scholar
    • Export Citation
  • 10

    Liu P, Han C, Li DS, Hemorrhagic moyamoya disease in children: clinical, angiographic features, and long-term surgical outcome. Stroke. 2016;47(1):240243.

    • Search Google Scholar
    • Export Citation
  • 11

    Ge P, Zhang Q, Ye X, Clinical features, surgical treatment, and long-term outcome in children with hemorrhagic moyamoya disease. J Stroke Cerebrovasc Dis. 2018;27(6):15171523.

    • Search Google Scholar
    • Export Citation
  • 12

    Guzman R, Lee M, Achrol A, Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article. J Neurosurg. 2009;111(5):927935.

    • Search Google Scholar
    • Export Citation
  • 13

    Guzman R, Steinberg GK. Direct bypass techniques for the treatment of pediatric moyamoya disease. Neurosurg Clin N Am. 2010;21(3):565573.

    • Search Google Scholar
    • Export Citation
  • 14

    Miyamoto S, Akiyama Y, Nagata I, Long-term outcome after STA-MCA anastomosis for moyamoya disease. Neurosurg Focus. 1998;5(5):e5.

  • 15

    Scott RM, Smith JL, Robertson RL, Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg. 2004;100(2)(Suppl Pediatrics):142149.

    • Search Google Scholar
    • Export Citation
  • 16

    Shen W, Xu B, Li H, Enlarged encephalo-duro-myo-synangiosis treatment for moyamoya disease in young children. World Neurosurg. 2017;106:916.

    • Search Google Scholar
    • Export Citation
  • 17

    Isono M, Ishii K, Kamida T, Long-term outcomes of pediatric moyamoya disease treated by encephalo-duro-arterio-synangiosis. Pediatr Neurosurg. 2002;36(1):1421.

    • Search Google Scholar
    • Export Citation
  • 18

    Fung LW, Thompson D, Ganesan V. Revascularisation surgery for paediatric moyamoya: a review of the literature. Childs Nerv Syst. 2005;21(5):358364.

    • Search Google Scholar
    • Export Citation
  • 19

    Lee S, Rivkin MJ, Kirton A, Moyamoya disease in children: results from the International Pediatric Stroke Study. J Child Neurol. 2017;32(11):924929.

    • Search Google Scholar
    • Export Citation

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