Journal of neurosurgery. Pediatrics
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J Neurosurg Pediatr · Nov 2018
Indirect revascularization with the dural inversion technique for pediatric moyamoya disease: 20-year experience.
OBJECTIVENumerous surgical procedures facilitate revascularization of the ischemic brain in patients with moyamoya disease. Dural inversion is a technique in which flaps of dura mater centered around the middle meningeal artery are inverted, encouraging the formation of a rich collateral blood supply. This procedure has been used in combination with encephaloduroarteriosynangiosis for more than 20 years at the authors' institution for the treatment of pediatric moyamoya disease. ⋯ The cumulative 5-year Kaplan-Meier risk for stroke was 6.4%. CONCLUSIONSDural inversion is a useful technique of cerebral revascularization in pediatric moyamoya disease. A 20-year experience demonstrates the safety and efficacy of this technique with a relatively low rate of postoperative stroke, good functional outcomes, and favorable angiographic results.