1135. Long-term Outcome and Postoperative Complications Depend on the Method of Surgery in Pediatric Moyamoya Disease

Authors: Syuntaro Takasu; Yutaro Fuse; Yugo Kishida; Yukio Seki (Nagoya, Japan)

Introduction: It has not been elucidated if the invasiveness of revascularization surgery affects long-term outcomes and postoperative complications in pediatric patients with moyamoya disease (MMD). Methods: A total of 72 pediatric patients (<16 years old) who underwent the initial revascularization surgery in our institute from July 1998 to September 2013 and followed up for a minimum of five years were investigated retrospectively. Until November 2006 (1st period), combined revascularization surgery including direct and indirect anastomosis was performed in the middle cerebral artery (MCA) territory and indirect anastomosis was added in the anterior cerebral artery (ACA) territory through another small craniotomy in 49 patients (90 hemispheres). From December 2006 (2nd period), combined revascularization surgery including direct and indirect anastomosis that covered both the MCA and the ACA territories was carried out through a single large frontotemporal craniotomy in 23 patients (36 hemispheres). Results: Postoperative complications observed in the 1st period included 17 cases (18.9%) of transient neurological events (TNEs) and 6 cases (6.7%) of cerebral infarction. Those observed in the 2nd period included 14 cases (38.9%) of TNEs and 6 cases (16.7%) of cerebral infarction. The incidence of postoperative TNEs was significantly higher in patients operated in the 2nd period, and there was a tendency that the postoperative cerebral infarction occurred more frequently in the 2nd period. Regarding long-term outcomes, a good neurological status (modified Rankin Scale score 0-2) at the last follow-up was achieved in 44 cases (89.8%) in the 1st period group and in 21 cases (91.3%) in the 2nd period group, and there was no statistical difference between the groups. Conclusion: The combined revascularization surgery covering both ACA and MCA territories is effective to achieve good long-term outcomes in pediatric patients with MMD, but appropriate range of indirect anastomosis needs to be considered to avoid postoperative ischemic complications.