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Challenging direct bypass surgery for very young children with moyamoya disease: technical notes

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Abstract

Cerebral revascularization for moyamoya disease (MMD) is an effective treatment for improving cerebral ischaemia and preventing rebleeding. Although direct bypass surgery is commonly performed on older children and adults, it is challenging in very young children due to the high difficulty level of the procedure. The subjects were MMD patients under 3 years of age on whom surgery was performed by a single surgeon (Y.A.). Preoperative clinical findings, information related to direct bypass surgery, bypass patency, and the incidence of postoperative stroke were investigated. Combined revascularization, including direct bypass surgery, was performed on 3 MMD patients (3 sides) under 3 years of age. The average diameter of the grafts used in direct bypass was 0.8 mm. The average recipient diameter was 0.8 ± 0.17 (range 0.6–1) mm. In all cases, the anastomotic procedure was completed using 11–0 monofilament nylon thread, and patency was confirmed. Direct bypass for MMD patients under 3 years old is technically challenging. However, despite the anatomical differences between very young children and elderly individuals, direct bypass surgery could certainly be completed. In addition, a rapid recovery from cerebral blood flow insufficiency could yield a promising neurological outcome.

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Data availability

The data and materials that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This work was funded by a grant from the Japan Society for the Promotion of Science (No. 7118K08967, https://www.jsps.go.jp).

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Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, Japan

    Yoshio Araki, Kenji Uda, Kinya Yokoyama, Fumiaki Kanamori, Michihiro Kurimoto, Yoshiki Shiba, Takashi Mamiya, Masahiro Nishihori, Kazuhito Takeuchi, Kuniaki Tanahashi, Yuichi Nagata, Yusuke Nishimura, Takashi Izumi & Ryuta Saito

  2. Aichi Rehabilitation Hospital, 1-1 Nishigara, Ehara Town, Nishio City, Aichi, Japan

    Sho Okamoto

  3. Department of Neurosurgery, Toyota Kosei Hospital, 500-1 Ibobara, Josui-cho, Toyota City, Aichi, Japan

    Masaki Sumitomo

Authors
  1. Yoshio Araki
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  2. Kenji Uda
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  3. Kinya Yokoyama
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  4. Fumiaki Kanamori
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  6. Yoshiki Shiba
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  15. Takashi Izumi
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  16. Ryuta Saito
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Contributions

Conception and design: YA and KU. Data acquisition: YA, KY, KU, FK, MK, YS, and TM. Drafting of the article: YA and KU. Statistical analysis: YA. Critical revision and advice: MN, KT, YN, YN, SO, and TI. Supervision: RS.

Corresponding author

Correspondence to Yoshio Araki.

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The ethics committee of Nagoya University Hospital approved this study.

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Written informed consent for participation in the study was received from all subjects.

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Written informed consent for publication was received from all subjects.

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The authors declare no competing interests.

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Araki, Y., Uda, K., Yokoyama, K. et al. Challenging direct bypass surgery for very young children with moyamoya disease: technical notes. Neurosurg Rev 45, 1799–1807 (2022). https://doi.org/10.1007/s10143-021-01685-0

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  • DOI: https://doi.org/10.1007/s10143-021-01685-0

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