1. Clinical outcomes after revascularization for pediatric moyamoya disease and syndrome: A single-center series.
- Author
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Morshed, Ramin A., Abla, Adib A., Murph, Daniel, Dao, Jasmin M., Winkler, Ethan A., Burkhardt, Jan-Karl, Colao, Kathleen, Hetts, Steven W., Fullerton, Heather J., Lawton, Michael T., Gupta, Nalin, and Fox, Christine K.
- Abstract
• The rate of direct bypass failure in children is low (5.7%). • A combined revascularization technique is feasible even for very young children. • High preoperative PSOM predicts worse good clinical outcome on follow-up. • Children < 5.4 years old with moyamoya have worse clinical outcomes. Moyamoya is a progressive cerebrovascular arteriopathy that affects children of any age. The goal of this study was to determine imaging and clinical outcomes as well as complication rates in a pediatric cohort undergoing either a combined direct/indirect or indirect-only revascularization approach. Patients with moyamoya disease or syndrome ≤ 18 years of age at the time of initial surgery were identified, and clinical data were collected retrospectively. Over a 12-year period, 26 patients underwent revascularization procedures on 49 hemispheres with a median follow-up of 2.6 years from surgery. Median age at surgery was 7.3 years (range 1.4–18.0 years). Thirty-three hemispheres (67.3%) underwent combined revascularization with a direct bypass and encephalomyosynangiosis, and sixteen hemispheres (32.7%) underwent indirect-only revascularization. The rate of 30-day perioperative complication was 10.2%, and the rate of postoperative clinical stroke by end of follow-up was 10.2% by hemisphere. There was a 5.7% rate of intraoperative bypass failure requiring conversion to an indirect revascularization approach. On follow-up imaging, 96.9% of direct bypasses remained patent. On multivariate analysis, higher preoperative Pediatric Stroke Outcome Measure (PSOM) scores were associated with lower rates of good clinical outcome on follow-up (unit OR 0.03; p = 0.03). Patients with age < 5.4 years had lower rates of good clinical outcome on follow-up. In this North American cohort, both combined direct/indirect and indirect only revascularization techniques were feasible. However, younger children < 5.4 years of age have worse outcomes than older children, similar to east Asian cohorts. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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