Occipital artery to middle cerebral artery bypass in pediatric moyamoya disease: rescue therapy after failed revascularization

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  • 1 Department of Neurosurgery, Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba, Japan;
  • 2 Department of Neurosurgery, Juha Hernesniemi International Center for Neurosurgery, Henan People’s Provincial Hospital, University of Zhengzhou, China; and
  • 3 Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
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OBJECTIVE

Patients with pediatric moyamoya disease (PMMD) showing recurrent symptoms or decreased cerebral blood flow after initial revascularization therapy may require additional revascularization to improve their clinical condition. The authors evaluated the clinical and hemodynamic benefits of an occipital artery (OA)–middle cerebral artery (MCA) bypass for patients with PMMD who have undergone an initial revascularization procedure.

METHODS

The authors retrospectively identified 9 patients with PMMD who had undergone OA-MCA bypass between March 2013 and December 2017, and who had received a previous superficial temporal artery–MCA bypass. The following clinical data were collected: initial revascularization procedure, symptoms (presence or recurrence), pre- and postoperative cerebral blood flow and cerebrovascular reactivity (CVR) changes, posterior cerebral artery (PCA) stenosis, PCA-related and nonrelated symptoms, and latest follow-up.

RESULTS

Preoperatively, all patients (n = 9) suffered non–PCA-related recurrent symptoms, and 4 had PCA-related symptoms. At 1-year follow-up, all patients with PCA-related symptoms showed complete recovery. Additionally, 8 (89%) patients with non-PCA symptoms experienced improvement. Only 1 (11%) patient showed no improvement after the surgical procedure. The mean pre- and postoperative CVR values of the MCA territory were 14.8% and 31.3%, respectively, whereas the respective mean CVR values of the PCA territory were 22.8% and 40.0%.

CONCLUSIONS

The OA-MCA bypass is an effective rescue therapy to improve the clinical condition and hemodynamic changes caused by PMMD in patients who experience recurrent symptoms after initial revascularization.

ABBREVIATIONS ACA = anterior cerebral artery; CBF = cerebral blood flow; CVR = cerebrovascular reactivity; DSA = digital subtraction angiography; ECA = external carotid artery; ICA = internal carotid artery; 123I-IMP = iodine-123 N-isopropyl iodoamphetamine; MCA = middle cerebral artery; MMD = moyamoya disease; MRA = MR angiography; OA = occipital artery; PCA = posterior cerebral artery; PMMD = pediatric MMD; STA = superficial temporal artery; TIA = transient ischemic attack.

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Contributor Notes

Correspondence Akitsugu Kawashima: Tokyo Women’s Medical University, Yachiyo Medical Center, Chiba, Japan. kawashima18surg@yahoo.co.jp.

INCLUDE WHEN CITING Published online January 15, 2021; DOI: 10.3171/2020.8.PEDS20424.

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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