• World Neurosurg · Jan 2020

    Brain compression by encephalo-myo-synangiosis is a risk factor for transient neurological deficits after surgical revascularization in pediatric patients with moyamoya disease.

    • Fumiaki Kanamori, Yoshio Araki, Kinya Yokoyama, Kenji Uda, Masahiro Nishihori, Takashi Izumi, Sho Okamoto, and Toshihiko Wakabayashi.
    • Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya City, Japan. Electronic address: shitetsu314@hotmail.co.jp.
    • World Neurosurg. 2020 Jan 1; 133: e558-e566.

    ObjectiveIn pediatric patients with moyamoya disease, the pathophysiology of transient neurological deficits and the clinical features of perioperative cerebral blood flow (CBF) changes are unclear. The purpose of this study was to investigate the risk factors of postoperative transient neurological deficits and identify predictors of perioperative CBF changes.MethodsThis retrospective study included 42 surgical procedures in 28 pediatric patients who underwent surgical revascularization for moyamoya disease, including encephalo-myo-synangiosis (EMS) with or without superficial temporal artery-middle cerebral artery (MCA) anastomosis. Magnetic resonance images and single photon emission computed tomography results were obtained. Brain compression by EMS was also checked in fluid attenuated inversion recovery images. Using single photon emission computed tomography, CBF was measured at each anterior and posterior part of the MCA region.ResultsPostoperative transient neurological deficits were observed in 12 (28.6%) out of 42 surgical procedures. Brain compression by EMS was a significant risk for transient neurological deficits (P = 0.009). The postoperative CBF in the anterior region increased in 9 cases (21.4%) and decreased in 10 cases (23.8%); in the posterior region, it increased in 12 cases (28.6%) and decreased in 10 cases (23.8%). Preoperative CBF of the anterior region was significantly related to both perioperative CBF changes in the MCA regions (anterior part, P = 0.004; posterior part, P = 0.025).ConclusionsBrain compression by EMS is a risk factor for postoperative transient neurological deficits in pediatric patients with moyamoya disease, and preoperative CBF of the anterior MCA region could predict perioperative CBF change in the MCA regions.Copyright © 2019 Elsevier Inc. All rights reserved.

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