Comment on: Surgical revascularization for childhood moyamoya, Child's Nerv Syst 28: 1041–1048, 2012

Abstract

Dear Editor: I enjoyed the article by Ng and colleagues “Surgical Revascularization for Childhood Moyamoya,” published in Child's Nervous System, volume 28:1041–1048, 2012. The article is a well-written summary of the experience at Great Ormond Street with this entity; I especially liked the comparison tables that the authors provided regarding other series in the literature, along with the time lines of their patients followed up for extended periods—an excellent graphic method for depicting the effect of surgery on control of symptoms in these patients, who appear to have a variable rate of progression of their arteriopathy. I do wish to gently object to the “mortality” figures that are provided in their table for referencing our article published in the Journal of Neurosurgery: Pediatrics, volume 100:142–149, 2004. In that table, the authors state under mortality that two of our patients died. Both of these patients in fact represent long-term deaths, one occurring 5 years after her surgery for moyamoya from the invasive growth of a radiation-induced malignant meningioma and the second patient dying 6 years after surgery from the rupture of an untreatable lenticulostriate aneurysm. The reader might infer from reviewing the table that these patients represented operative deaths, when in fact our series and others in the literature demonstrate a negligible operative mortality rate.