EFFECTS OF SURGICAL REVASCULARIZATION ON OUTCOME OF PATIENTS WITH PEDIATRIC MOYAMOYA DISEASE

Background and Purpose We reviewed surgically treated patients with pe diatric moyamoya disease and examined whether vasoreconstructive surge ries reduced the risk of recurrent ischemic attacks and changed overal l outcomes in terms of the patients' performance and intellectual stat us. Methods Sixty-four hemispheric sides in 34 pediatric moyamoya dise ase patients who received surgical treatment were examined. We perform ed superficial temporal artery to middle cerebral artery (STA-MCA) byp ass and encephalo-duro-arterio-myo-synangiosis (EDAMS) on 48 sides (co mbined group) and indirect bypass surgery such as EDAMS on 16 sides (i ndirect group). These 34 patients were observed postoperatively from 1 to 14 years (mean +/- SD, 6.6 +/- 3.8 years) and were examined for th e incidence of recurrent ischemic attack. Of the 34 patients, 23 were followed up for > 5 postoperative years, and their overall outcomes in terms of their performance and intellectual status were determined. R esults Perioperative ischemic events (less than or equal to 2 weeks af ter surgery) occurred in 5 surgeries (31%) of the indirect group and i n 6 (13%) of the combined group (P = NS). The incidence of postoperati ve ischemic events (> 2 weeks after surgery) was significantly reduced in the combined group (10%) compared with the indirect group (56%; P < .01). Of the 23 patients observed > 5 years, 7 patients (30%) were m entally retarded and regarded as having a fair outcome. Conclusions Co mbined surgery (STA-MCA bypass with EDAMS) for pediatric moyamoya dise ase was effective in reducing the risk of postoperative ischemic attac ks compared with indirect surgery. Surgical revascularization may be e ffective in preventing intellectual deterioration and improving overal l outcome.