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“STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis” as a one-staged revascularization strategy for pediatric moyamoya vasculopathy

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Abstract

Purpose

Moyamoya vasculopathy progressively compromises cerebral blood flow resulting in chronic hypoperfusion. The middle cerebral artery (MCA) territory and the bifrontal areas are the regions most frequently affected. Although most techniques aim to only revascularize the MCA territory, augmentation of blood flow of the bifrontal areas is of importance in the pediatric moyamoya population since these regions play an important role in cognition, intellectual development, and in lower extremity and sphincter function. We recently described a one-staged surgical procedure combining revascularization of three regions, the MCA territory unilaterally and the frontal areas bilaterally. The purpose of this article is to report our surgical experience in eight children and to emphasize the rational for bifrontal revascularization.

Methods

We report a case series consisting of eight children where the following surgical strategy was applied: (1) a direct superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass with encephalo-duro-myo-synangiosis (EDMS) for unilateral MCA revascularization; in combination with (2) a bifrontal encephalo-duro-periosteal-synangiosis (EDPS) for bifrontal revascularization. Patients’ characteristics and 30-day follow-up data are reported.

Results

The patient group consisted of six girls and two boys (mean age 10.0, range 4.2–17.5 years): six children presented with moyamoya disease, two with moyamoya syndrome. We performed a one-staged revascularization of one MCA territory and both frontal areas in all patients. No significant complications occurred. Two patients experienced postoperative focal seizures, successfully treated with anti-epileptic medication.

Conclusions

The single-staged STA-MCA bypass with EDMS combined with bifrontal EDPS allowed revascularization of three regions (the MCA territory unilaterally and the frontal areas bilaterally) and may serve as an alternative and safe treatment option for pediatric moyamoya patients.

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Acknowledgments

The authors thank Mr. Peter Roth (Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland) for the drawings in Fig. 2.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091, Zürich, Switzerland

    Giuseppe Esposito, Jorn Fierstra & Luca Regli

  2. Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Annick Kronenburg, Catharina J. M. Klijn & Albert van der Zwan

  3. Pediatric Neurology, Brain Center Rudolf Magnus, UMC Utrecht, Heidelberglaan 100, 3508 AB, Utrecht, The Netherlands

    Kees P. J. Braun

Authors
  1. Giuseppe Esposito
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  2. Annick Kronenburg
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  5. Catharina J. M. Klijn
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  7. Luca Regli
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Correspondence to Giuseppe Esposito.

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Esposito, G., Kronenburg, A., Fierstra, J. et al. “STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis” as a one-staged revascularization strategy for pediatric moyamoya vasculopathy. Childs Nerv Syst 31, 765–772 (2015). https://doi.org/10.1007/s00381-015-2665-y

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