Encephaloduromyosynangiosis treating moyamoya disease in young children

Abstract

Objectives To evaluate the therapeutic effect of encephaloduromyosynangiosis (EDMS) in young children for moyamoya disease(MMD). Methods Twenty-seven MMD chilidren confirmed by digital subtraction angiography (DSA) or magnetic resonance angiography (MRA) in our center were admitted between January 2011 and September 2013. The clinical manifestation was described as below: 1 with cerebral hemorrhage history, 26 with Ischemic history. Eight left brain hemispheres, 6 right hemispheres and 13 bilateral hemispheres were operated. All the procedures were performed within (136±22) min with (21±3) ml blood loss. Results The mean period of follow-up after surgery was 15.8 months, with a range of 6-38 months. (1)The cerebral blood flow in the effected regions was increased 3 months after the operations, all cases got vascularization. The spontaneous revascularization from the deep temporal artery, superficial temporal artery and the middle meningeal artery was found in DSA or MRA.(2)Twenty-seven SPECT reviewed cases had better perfusion after the operation. (3)The ischemic symptoms were relieved in 31 (77.5%) hemispheres, while stabilized in 8 (20.0%) hemispheres. There were 4 cerebral infarctions (10%) within one month after the operation, 1 located in the operated hemisphere, while 3 in the contralateral sites. Conclusions EDMS was a safe, effective and secluded treatment for MMD in young children. The extracranial vessels could be revascularized in a multi-layered extensively manner, which significantly improved patients′ neurological function. Key words: Moyamoya disease; Cerebral revascularization; Children