Anesthetic Management During Posterior Spinal Fusion in a Patient With Moyamoya

Abstract

Moyamoya disease is an arteriopathy of the vasculature of the central nervous system that predisposes patients to cerebrovascular ischemia and thrombotic strokes. It is characterized by a progressive narrowing of the intracranial component of the internal carotid arteries as well as the proximal branches of the anterior and middle cerebral arteries thereby predisposing patients to episodes of cerebrovascular insufficiency. Moyamoya disease adds an additional level of complexity to the anesthetic care of patients undergoing major surgical procedures related to concerns of maintaining adequate cerebral perfusion and oxygenation. These patients may present with a history of transient ischemic attacks or cerebrovascular accidents with resultant neurological deficits, cognitive delay and seizures at baseline. We present an 18-year-old woman with moyamoya disease who required anesthetic care during a posterior spinal fusion for a neuromuscular disorder. Physiological parameter management intraoperatively is discussed and options for anesthetic care are presented with an emphasis on the use of near infrared spectroscopy to monitor cerebral oxygenation.