Posterior cerebral artery stenosis and posterior circulation revascularization surgery in pediatric patients with moyamoya disease.
J Neurosurg Pediatr
; 21(6): 632-638, 2018 06.
Article
em En
| MEDLINE
| ID: mdl-29624146
ABSTRACT
OBJECTIVE Some pediatric patients with moyamoya disease (MMD) present with posterior cerebral artery (PCA) stenosis before and after anterior circulation revascularization surgery and require posterior circulation revascularization surgery. This study evaluated the factors associated with PCA stenosis and assessed the efficacy of posterior circulation revascularization surgery, including occipital artery (OA)-PCA bypass, in pediatric patients with MMD. METHODS The presence of PCA stenosis before and after anterior circulation revascularization surgery and its clinical characteristics were investigated in 62 pediatric patients (< 16 years of age) with MMD. RESULTS Twenty-three pediatric patients (37%) with MMD presented with PCA stenosis at the time of the initial diagnosis. A strong correlation between the presence of infarction and PCA stenosis before anterior revascularization was observed (p < 0.001). In addition, progressive PCA stenosis was observed in 12 patients (19.4%) after anterior revascularization. The presence of infarction and a younger age at the time of initial diagnosis were risk factors for progressive PCA stenosis after anterior revascularization (p < 0.001 and p = 0.002, respectively). Posterior circulation revascularization surgery, including OA-PCA bypass, was performed in 9 of the 12 patients with progressive PCA stenosis, all of whom showed symptomatic and/or radiological improvement. CONCLUSIONS PCA stenosis is an important clinical factor related to poor prognosis in pediatric MMD. One should be aware of the possibility of progressive PCA stenosis during the postoperative follow-up period and consider performing posterior circulation revascularization surgery.
Palavras-chave
123I-IMP = N-isopropyl-p-[123I] iodoamphetamine; ACA = anterior cerebral artery; CBF = cerebral blood flow; CPP = cerebral perfusion pressure; CVR = cerebrovascular reserve; EDMS = encephaloduromyosynangiosis; ICA = internal carotid artery; MCA = middle cerebral artery; MMD = moyamoya disease; MRA = MR angiography; OA = occipital artery; PCA = posterior cerebral artery; STA = superficial temporal artery; TIA = transient ischemic attack; moyamoya disease; posterior cerebral artery; posterior circulation revascularization surgery; vascular disorders
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Revascularização Cerebral
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Constrição Patológica
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Procedimentos Neurocirúrgicos
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Artéria Cerebral Posterior
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Doença de Moyamoya
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article