SURGICAL APPROACHES FOR TREATMENT OF ISCHEMIC CEREBRAL STROKE OTHER THAN MOYAMOYA DISEASE IN CHILDREN

Ischaemic cerebral strokes in children are relatively uncommon. With t he exception of patients with moyamoya disease, there is no effective treatment for these lesions. One potential approach is encephalo-duro- arterio-synangiosis (EDAS). This is a safe neu rosurgical procedure th at promotes spontaneous transdural anastomosis that may provide additi onal blued now to ischaemic regions. We present eight children with is chaemic strokes other than moyamoya disease, and discuss surgical atte mpts to treat this entity. The mean age of the eight children was 3.6 years (range: 13 months to 9 years). All children presented with acute childhood hemiplegia. Ischaemic stroke had occurred in association wi th a head injury in three children. but without on apparent cause in f ive. Five children underwent stable xenon-enhanced computed tomography to evaluate cerebral blood flow and all but one patient under went ED AS. One child with no angiographic abnormalities recovered to a normal neurological state without surgery. Following surgery, another child also fully recovered, and the remaining six children recovered with on ly a slight hemiparesis. Revascularization was observed on a follow-up angiogram in three children. Our surgical experiences suggest that re vascularization is influenced by haemodynamic demand and recanalizatio n of the occluded artery, We favour the use of indirect anastomosis (E DAS) for selected patients and suggest that chronic ischaemia probably contributes to surgical success.