• Masahito Kawabori, Satoshi Kuroda, Naoki Nakayama, Kenji Hirata, Toru Shiga, Kiyohiro Houkin, and Nagara Tamaki.
• Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
• World Neurosurg. 2013 Nov 1;80(5):612-9.

BackgroundHeadache is one of the major clinical presentations in pediatric Moyamoya disease. However, the clinical features and underlying mechanisms are not fully understood. This study aimed to clarify the clinical feature of headache in pediatric Moyamoya disease and the effect of surgical revascularization.MethodsThis study included 29 pediatric patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass for Moyamoya disease. Their medical records were precisely evaluated to identify the clinical features of their headache. The findings on magnetic resonance imaging, positron emission tomography, and single-photon emission computed tomography also were analyzed.ResultsPreoperative headache was documented in 11 (38%) of 29 patients. The majority of them complained of severe headache in the frontal or temporal region in the morning. Headache was significantly related to more advanced disease stage and to the decreases in cerebral blood flow and its reactivity to acetazolamide. Surgical revascularization completely resolved headache in all 11 patients.ConclusionsThese findings strongly suggest that disturbed cerebral hemodynamics may play key roles in developing severe headache in pediatric Moyamoya disease. STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis may be effective procedures to rapidly resolve headache by widely supplying collateral blood flow to the operated hemispheres.Copyright © 2013 Elsevier Inc. All rights reserved.

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