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Posterior cerebral territory ischemia in pediatric moyamoya: Surgical techniques and long-term clinical and radiographic outcomes

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Abstract

Purpose

To describe a surgical technique for posterior cerebral revascularization in pediatric patients with moyamoya arteriopathy. Here, we describe the clinical characteristics, surgical indications, operative techniques, and clinical and radiographic outcomes in a series of pediatric patients with moyamoya disease affecting the posterior cerebral artery (PCA) territory.

Methods

A retrospective single-center series of all pediatric patients with moyamoya disease who presented to our institute between July 2009 through August 2019 were reviewed. The clinical characteristics, surgical indications, operative techniques, and long-term clinical and radiographic outcomes of pediatric moyamoya patients with PCA territory ischemia were collected and analyzed.

Results

A total of 10 PCA revascularization procedures were performed in 9 patients, 5 female, ages 1 to 11.1 years (average 5.2 years). Complications included 1 stroke, with no infections, hemorrhages, seizures, or deaths. One patient had less than 1 year of radiographic and clinical follow-up. In 8 of 9 patients with at least 1 year of radiographic follow-up, there was engraftment of surgical vessels present in all cases. No new strokes were identified on long-term follow-up despite the radiographic progression of the disease. In the 8 cases available for analysis, the average follow-up was 50.8 months with a range of 12 to 117 months.

Conclusions

PCA territory ischemia in patients with progressive moyamoya disease can be surgically treated with indirect revascularization. Here, we describe our experience with PCA revascularization procedures for moyamoya disease, including pial pericranial dural (PiPeD) revascularization and pial synangiosis utilizing the occipital artery. These surgical options may be useful for decreasing the risk of stroke in pediatric moyamoya patients with severe posterior circulation disease.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

    Alaa Montaser

  2. Vascular Biology Program, Department of Neurosurgery Boston Children’s Hospital, Hunnewell 2nd floor, 300 Longwood Ave, Harvard Medical School, Boston, MA, 02115, USA

    Ari D. Kappel, Jessica Driscoll, Emily Day, Madeline Karsten, Alfred P. See & Edward R. Smith

  3. Department of Interventional Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Ari D. Kappel, Alfred P. See & Darren B. Orbach

  4. Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Ari D. Kappel

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  1. Alaa Montaser
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  2. Ari D. Kappel
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  4. Emily Day
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Contributions

ERS, AM, DBO, and APS contributed to conception and design of the study. AM was responsible for data collection, analysis, and initial draft of the manuscript. ADK was responsible for data collection, preparing figures, analysis and additional manuscript drafts and revisions. JD, ED, and MK were responsible for chart abstraction, data collection, and initial analysis. All authors contributed to cohort ascertainment and data collection. All authors contributed to writing and reviewing the manuscript.

Corresponding author

Correspondence to Edward R. Smith.

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Montaser, A., Kappel, A.D., Driscoll, J. et al. Posterior cerebral territory ischemia in pediatric moyamoya: Surgical techniques and long-term clinical and radiographic outcomes. Childs Nerv Syst 40, 791–800 (2024). https://doi.org/10.1007/s00381-023-06219-1

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  • DOI: https://doi.org/10.1007/s00381-023-06219-1

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