• Eun Jin Ha, Ji Hoon Phi, Ji Yeoun Lee, Eun Jung Koh, Kyung Hyun Kim, Kyu-Chang Wang, Byung-Kyu Cho, and Seung-Ki Kim.
• Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul , Republic of Korea.
• Neurosurgery. 2023 Oct 1; 93 (4): 901909901-909.

BackgroundThe prognosis of moyamoya disease (MMD) in young children (younger than 4 years) is worse than that of older adults. The effectiveness of surgery is still inconclusive.ObjectiveTo evaluate long-term outcomes after indirect bypass in young children with MMD.MethodsA total of 1417 MMD children underwent indirect bypass from August 1988 to October 2020. This study included 135 patients who were younger than 4 years at the time of surgery. The clinical features and surgical outcomes of these patients were assessed. We analyzed the long-term outcome of 102 children who were followed up for more than 5 years (mean: 18.8 years, range: 5-27.3 years). Cross-sectional analysis was performed to evaluate overall outcomes based on the Lansky Play Performance Scale (LPS). The annual risk of symptomatic stroke after surgery was calculated with a person-year method, and the event-free survival rate was evaluated using the Kaplan-Meier method.ResultsThe overall clinical outcome was favorable (LPS ≥ 80) in 88% of the patients. The overall postoperative adverse event rate was 15%, including 1 death. At the last follow-up, 86% of patients who had seizures at diagnosis were seizure-free. During the follow-up, there were 3 symptomatic infarctions on the operated hemisphere (postoperative 3, 3, and 10 months each). There was no hemorrhagic event. The annual infarction rate was 0.16% per person-year. The 20-year event-free survival rates for symptomatic infarction were 97%.ConclusionIndirect bypass could provide a satisfactory long-term outcome and prevent recurrent stroke in young children with MMD.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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