Surgical Revascularization for Children with Moyamoya Disease: A New Modification to the Pial Synangiosis.

Abstract

To summarize therapeutic efficacy of modified pial synangiosis in children with moyamoya disease and our experience with this method. A retrospective study was conducted to analyze clinical efficacy of modified pial synangiosis in children with moyamoya disease who were treated between October 2002 and August 2015 at our center. Clinical characteristics of these rare cases were summarized, and surgical efficacy was assessed based on long-term follow-up results. We employed modified pial synangiosis to treat 10 children with moyamoya disease; 18 modified pial synangiosis procedures were performed. The study included 2 boys and 8 girls (mean age at disease onset, 6.5 years ± 2.6). According to preoperative digital subtraction angiography, Suzuki grade III was noted in 80% (16/20) of hemispheres, and Suzuki grade II was noted in the remaining hemispheres (4/20). Mean follow-up period was 63.4 months ± 36.0. During the follow-up period, 2 cases of transient ischemic attack were reported. The remaining patients had no evidence of cerebral ischemia, seizures, or cerebral hemorrhage. Postoperative assessments based on Matsushima classification scores showed that patients with grade A revascularization accounted for 66.7% (12/18) of treated hemispheres, patients with grade B accounted for 27.8% (5/18), and patients with grade C accounted for 5.6% (1/18). Our clinical findings provide data on efficacy and safety of modified pial synangiosis, but analysis of more cases is necessary to draw solid conclusions. A randomized controlled study is required to verify improved surgical efficacy of modified pial synangiosis.