Vascular Architecture Characters and Changes of Pediatric Moyamoya Disease after Combined Bypass Surgery.

Abstract

We aimed to analyze the angioarchitecture characters and changes after combined bypass surgery (CBS) in pediatric moyamoya disease (MMD). We retrospectively analyzed our database of consecutive patients with moyamoya angiopathy who received treatment. Only pediatric MMD cases aged between 3 and 19 years with pre- and post-operative imaging examinations including digital subtraction angiography and magnetic resonance imaging were enrolled in this study. The main trunk vessels' stenosis and the collaterals from the superficial-meningeal system and deep parenchymal system were evaluated before and after CBS. During short-term follow-up period after the unilateral CBS, the stenosis of main trunk vessels both in operative (5.7 ± 2.1 vs. 6.8 ± 1.8; p < 0.001) and non-operative hemisphere (non-operative side 4.3 ± 1.9 vs. 5.7 ± 2.1; p < 0.001) progressed obviously. During the median follow-up period of 28.5 months after CBS, the decrease of posterior cerebral artery middle cerebral artery (PCA-MCA) anastomoses was much more significant (26 vs. 6, p < 0.001) than that of the PCA anterior cerebral artery anastomoses (18 vs. 19, p = 0.807). Meanwhile, the subependymal anastomotic network could be relieved obviously (27 vs. 2, p < 0.001), while the inner thalamic and striatal anastomotic network showed no significant change (31 vs. 25, p = 0.109). The successful CBS could decrease the collaterals from the PCA-MCA leptomeningeal system and the subependymal compensations in deep parenchyma significantly, while the main trunk stenosis would aggravate rapidly both in operative and non-operative hemisphere in short-term follow-up after unilateral CBS. Therefore, strict and regular follow-ups for the changes of vascular architecture and prompt surgical intervention for the contralateral side might be of benefit to pediatric MMD.