Neurovascular Syndromes

Keith, Kristin; Reed, Laura K.; Nguyen, Anthony; Qaiser, Rabia

doi:10.1016/j.nec.2021.09.010

Cited by 1 publication

(2 citation statements)

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“…It is a progressive disease, and patients suffer from repeated strokes, accumulating neurologic injuries. The condition preferentially affects the anterior circulation, compromising the territories supplied by the middle cerebral artery (MCA) and anterior cerebral artery (ACA) [ 2 ]. The prognosis of MMD is worse in younger patients compared to older patients [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

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Indirect Bypass With Pericranial Transposition for Moyamoya Syndrome in an Infant

Ajala,

Nguyen,

Lyon

et al. 2023

Cureus

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Moyamoya syndrome (MMS) is a progressive disease that can result in debilitating strokes. Surgical revascularization is the mainstay of treatment. Selection of the proper bypass technique depends on the vascular anatomy and location of the hypoperfused cerebral territory. We describe here a case of successful indirect bypass utilizing a pericranial flap as well as dural inversion. A seven-month-old female was transferred from an outside facility to our institution for further evaluation and surgical treatment of MMS. She presented with bilateral brain infarcts worse on the left, with right-sided body weakness. After medical stabilization and hyperhydration, she was taken to the operating room for a left-sided indirect bypass. The superficial temporal artery (STA) was traced utilizing doppler but was determined to be too diminutive for transposition, so the decision was made to proceed with encephalo-duro-pericranio-synangiosis (EDPS). A pericranial graft was successfully affixed to the cortical surface in the hypoperfused middle cerebral artery (MCA) territory, and the dura was inverted. Postoperatively, the patient developed a pseudomeningocele, so a revision surgery was performed. She was discharged shortly after this and returned for encephalo-duro-arterio-synangiosis (EDAS) of the contralateral side. She followed up three months after her initial bypass surgery at age 10 months and was crawling without any focal deficits. She was lost to follow-up thereafter. EDPS is a safe technique for infants with MMS whose STA is too diminutive to be used for bypass surgery. This may be an effective method for indirect bypass in these patients.

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Section: Introductionmentioning

confidence: 99%

“…The prognosis of MMD is worse in younger patients compared to older patients [ 3 ]. While medical management does not reverse the condition, surgical options are available to reperfuse the brain in selective cases [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%