Preservation of the Arachnoid Membrane During Encephaloduroarteriosynangiosis (EDAS) Reduces Post-Operative Complications Without Undermining the Surgical Outcome in Paediatric Moyamoya Disease

Abstract

Background: Encephaloduroarteriosynangiosis (EDAS) is a commonly used indirect revascularization operation method to treat pediatric Moyamoya disease (MMD) patients. Arachnoid dissection has been frequently performed during the EDAS operation in an effort to promote better revascularization. However, no studies have yet proven its surgical benefits. In this study, we investigated the impact of arachnoid preservation on the surgical outcome and post-operative complication by comparing pediatric MMD patients who had the arachnoid membrane preserved during EDAS operation with those who had the arachnoid membrane dissected. Methods: This was a retrospective cohort study based on a single institution, single surgeon's experience. A total of 206 pediatric MMD patients who underwent EDAS operation at Seoul National University Children's Hospital were recruited for the study. We compared the surgical outcomes of these two groups, as well as, post-operation complication rate. Furthermore, risk factors for post-operative complication were analyzed. Findings: The overall clinical outcome (p = 0.342) and the extent of revascularization of MCA territories (p = 0.736) were not different between the arachnoid dissection group and the arachnoid preservation group. However, post-operative infarction/hemorrhage rate was significantly higher in the arachnoid dissection group (p = 0.005). Arachnoid dissection (p = 0.011) and young age (less than 3 years old, less than 3 years, p = 0.012) were significantly associated with increased risk of post-operative complication. Interpretation: Arachnoid preservation may help to reduce post-operative complication without decreasing the surgical outcomes of EDAS operation. Furthermore, patient factors such as the patient's age should be taken into account when treating pediatric MMD patients. Funding Statement: This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI12C0066). Declaration of Interests: The authors state: There are no conflicts of interests. Ethics Approval Statement: The present study was a retrospective cohort study which was approved by the Seoul National University Hospital Institutional Review Board.