Moyamoya disease and syndrome among pediatric patients are often treated with surgical revascularization. There is limited literature regarding associations between preoperative angiography, postoperative angiography, and clinical outcomes, therefore, we wanted to further investigate the relationship between those variables.Methods: This is a case series of consecutive moyamoya disease (MMD) and moyamoya syndrome (MMS) pediatric patients who underwent pial synangiosis. Correlations between preoperative Suzuki stage, Matsushima grade at one year postoperatively, and pediatric modified Rankin score (mRS) were assessed using Spearmans rank correlation testing. Factors associated with angiographic and clinical outcomes were analyzed using Fishers Exact tests.
Forty patients (60 hemispheres) were treated with median follow up of 2.29 years. No significant correlation between preoperative Suzuki stage and postoperative Matsushima grade was identified overall. Suzuki stage two hemispheres developed less robust revascularization. Preoperative Suzuki stage was not associated with postoperative disability severity, whereas a nonsignificant trend towards improved clinical outcomes was observed with better Matsushima grade. Poor angiographic revascularization was more frequent in patients with preoperative ivy signs, preoperative NIHSS ?3, preoperative symptom duration more than 6 months, and MMS. Among MMS patients, those with Sickle cell disease had the poorest revascularization. Postoperative intracranial hemorrhage, reoperation, Suzuki stage ?5, and postoperative ischemic stroke conferred more unfavorable clinical outcomes whereas Matsushima A and B revascularization and symptom duration < 6 months were protective from unfavorable outcomes. Associated figures and tables will be listed for further clarification.
Although Suzuki stage does not significantly correlate with Matsushima grade, the degree of revascularization in these patients according to Matsushima grade is likely associated with clinical outcomes. Although multiple factors associated with degree of revascularization and clinical outcomes have been identified, further investigation with a larger sample size would be needed to better characterize this association.