General Principles for Pial Synangiosis in Pediatric Moyamoya Patients: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. E14-E15
Author(s):  
David L Penn ◽  
Kyle C Wu ◽  
Kayla R Presswood ◽  
Coleman P Riordan ◽  
R Michael Scott ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Horizontal Plane ◽  
Doppler Ultrasonography ◽  
Pediatric Patients ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Surgical Revascularization ◽  
Intravenous Hydration ◽  
Collateral Vessels ◽  
The Brain

Abstract Pial synangiosis is a method of indirect surgical revascularization developed at our institution for the treatment of moyamoya disease in pediatric patients. Similar surgical principles are employed in adult cases, often performed because of lack of an adequate donor vessel. Standardized protocols, including preadmission for preoperative intravenous hydration and aspirin administration, as well as intraoperative electroencephalography, are routinely employed to minimize operative risk. Perioperative heparinization is not required. The patient is positioned supine, without skull fixation, and the parietal branch of the superficial temporal artery is mapped with Doppler ultrasonography. The artery is microscopically dissected from distal to proximal, leaving a cuff of tissue around the vessel and elevated from the temporalis. The microscope is then removed, the temporalis is opened in a cruciate fashion, and a generous craniotomy is performed, with care to drill away from the exposed artery. The dura is then opened widely (preserving dural collateral vessels), followed by microscopic opening of the arachnoid in as many areas as possible. The donor vessel is then sutured to the pia with 10-0 nylons. The dural leaflets are laid on the brain (without suturing). Closure is completed with saline-soaked gelfoam, with fixation of the bone flap, and muscle reapproximation in the horizontal plane. The galea is closed, followed by the use of resorbable skin suture in pediatric patients. If indicated, the second hemisphere may be performed under the same anesthetic, reducing anesthetic risks and avoiding delayed revascularization. Postoperatively, the patient is awakened and transferred to the intensive care unit.

Effects of Surgical Revascularization on Peripheral Artery Aneurysms in Moyamoya Disease: Report of Three Cases

Neurosurgery ◽  
2001 ◽  
Vol 49 (2) ◽  
pp. 463-468 ◽  
Author(s):  
Satoshi Kuroda ◽  
Kiyohiro Houkin ◽  
Hiroyasu Kamiyama ◽  
Hiroshi Abe
Keyword(s):  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Intracranial Bleeding ◽  
Peripheral Artery ◽  
Surgical Revascularization ◽  
Beneficial Effects ◽  
Collateral Arteries ◽  
Lenticulostriate Artery ◽  
Collateral Vessels

Abstract OBJECTIVE AND IMPORTANCE The beneficial effects of surgical revascularization on rebleeding in moyamoya disease remain unclear. This report is intended to clarify the effects of surgical revascularization on peripheral artery aneurysms, which represent one of the causes of intracranial bleeding in moyamoya disease. CLINICAL PRESENTATION Findings for three female patients who experienced intracranial bleeding are presented. Cerebral angiography revealed that intracranial bleeding resulted from the rupture of peripheral artery aneurysms arising from dilated collateral vessels such as the lenticulostriate artery. INTERVENTION The patients successfully underwent superficial temporal artery-middle cerebral artery anastomosis combined with encephaloduromyoarteriosynangiosis. Angiography demonstrated obliteration of the peripheral artery aneurysms, together with the disappearance or decrease in caliber of the parent collateral arteries, after surgery. None of the patients experienced rebleeding during the follow-up period (up to 52 mo). CONCLUSION The results strongly suggest that surgical revascularization potentially improves cerebral circulation and decreases hemodynamic stress on collateral vessels, obliterating peripheral artery aneurysms.

Less Invasive Pedicled Omental-Cranial Transposition in Pediatric Patients With Moyamoya Disease and Failed Prior Revascularization

2013 ◽  
Vol 10 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Ramon Navarro ◽  
Kevin Chao ◽  
Peter A. Gooderham ◽  
Matias Bruzoni ◽  
Sanjeev Dutta ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Pediatric Patients ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Pedicled Flap ◽  
Resonance Imaging ◽  
Major Treatment ◽  
Omental Transposition ◽  
The Brain ◽  
Better Than

Abstract BACKGROUND: Patients with moyamoya disease and progressive neurological deterioration despite previous revascularization pose a major treatment challenge. Many have exhausted typical sources for bypass or have ischemia in areas that are difficult to reach with an indirect pedicled flap. Omental-cranial transposition has been an effective, but sparingly used technique because of its associated morbidity. OBJECTIVE: We have refined a laparoscopic method of harvesting an omental flap that preserves its gastroepiploic arterial supply. METHODS: The pedicled omentum can be lengthened as needed by dividing it between the vascular arcades. It is transposed to the brain via skip incisions. The flap can be trimmed or stretched to cover ischemic areas of the brain. The cranial exposure is performed in parallel with pediatric surgeons. We performed this technique in 3 pediatric patients with moyamoya disease (aged 5-12 years) with previous superficial temporal artery to middle cerebral artery bypasses and progressive ischemic symptoms. In 1 patient, we transposed omentum to both hemispheres. RESULTS: Blood loss ranged from 75 to 250 mL. After surgery, patients immediately tolerated a diet and were discharged in 3 to 5 days. The ischemic symptoms of all 3 children resolved within 3 months postoperatively. Magnetic resonance imaging at 1 year showed improved perfusion and no new infarcts. Angiography showed excellent revascularization of targeted areas and patency of the donor gastroepiploic artery. CONCLUSION: Laparoscopic omental harvest for cranial-omental transposition can be performed efficiently and safely. Patients with moyamoya disease appear to tolerate this technique much better than laparotomy. With this method, we can achieve excellent angiographic revascularization and resolution of ischemic symptoms.

Meningeal management for optimal revascularization from middle meningeal artery

2013 ◽  
Vol 118 (1) ◽  
pp. 104-108 ◽  
Author(s):  
Nancy McLaughlin ◽  
Neil A. Martin
Keyword(s):  
Integrated Management ◽  
Superficial Temporal Artery ◽  
Surgical Techniques ◽  
Middle Layer ◽  
Temporal Artery ◽  
Middle Meningeal Artery ◽  
Occipital Artery ◽  
The Brain ◽  
Median Layer ◽  
Meningeal Artery

Numerous surgical techniques have been developed and refined for the treatment of moyamoya disease. Among the indirect techniques of revascularization, encephaloduroarteriosynangiosis has been recognized as effective in promoting revascularization and reversing symptomatology. Neovascularization occurs between the donor artery, either the superficial temporal artery or the occipital artery, and the underlying ischemic cortex. Additionally, the middle meningeal artery and its dural branches have also been shown to contribute to collateral blood supply. In this report the authors describe an integrated management of the meninges for optimal revascularization. They emphasize the importance of recognizing the 3 major layers of the dura and describe a technique of dural splitting at the locus minoris resistentiae between the dura mater's vascular (middle) layer and internal median layer. Applying the dura's vascular layer to the surface of the brain after opening of the arachnoid is designed to optimize dural-pial synangiosis related to middle meningeal artery branches.

Doppler ultrasonography of superficial temporal artery in a cohort of patients with strong clinical suspicion of giant cell arteritis

2019 ◽  
Vol 153 (4) ◽  
pp. 151-153
Author(s):  
Paula Estrada Alarcón ◽  
Dèlia Reina ◽  
Vanessa Navarro Ángeles ◽  
Dacia Cerdà ◽  
Daniel Roig-Vilaseca ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Doppler Ultrasonography ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Clinical Suspicion

Spontaneous cerebral revascularization in a patient with STA-MCA anastomosis

1976 ◽  
Vol 44 (1) ◽  
pp. 84-87 ◽  
Author(s):  
James I. Ausman ◽  
James Moore ◽  
Shelley N. Chou
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Revascularization ◽  
Surgical Anastomosis ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors report a case with spontaneous revascularization of the brain after surgical anastomosis of the superficial temporal artery to the middle cerebral artery.

Surgical treatment for spontaneous carotid dissection with impending stroke

1984 ◽  
Vol 61 (2) ◽  
pp. 382-386 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Yoshihiro Kuriyama
Keyword(s):  
Superficial Temporal Artery ◽  
Rapid Evolution ◽  
Temporal Artery ◽  
Carotid Artery Dissection ◽  
Spontaneous Resolution ◽  
Artery Dissection ◽  
Carotid Dissection ◽  
Surgical Revascularization ◽  
Content Type ◽  
Fine Print

✓ A case of spontaneous carotid artery dissection is presented. In the case described, superficial temporal artery-middle cerebral artery anastomosis was performed because of impending stroke. Surgical revascularization is indicated in a case that shows such a rapid evolution of stroke that spontaneous resolution of the dissection cannot be awaited.

Incidence and Pathogenesis of Transient Cheiro-Oral Syndrome After Surgical Revascularization for Moyamoya Disease

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. 1054-1060 ◽  
Author(s):  
Toru Sasamori ◽  
Satoshi Kuroda ◽  
Naoki Nakayama ◽  
Yoshinobu Iwasaki
Keyword(s):  
Moyamoya Disease ◽  
Single Photon ◽  
Superficial Temporal Artery ◽  
Photon Emission ◽  
Temporal Artery ◽  
Disease Stage ◽  
Emission Computed Tomography ◽  
Rapid Progression ◽  
Surgical Revascularization ◽  
Progression Of Disease

Abstract BACKGROUND: There are no reports that denote transient cheiro-oral syndrome (COS) after surgical revascularization for moyamoya disease. OBJECTIVE: To clarify the incidence and pathogenesis of transient COS after surgical revascularization for moyamoya disease. METHODS: This study included 21 patients who underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis and indirect bypass because of Moyamoya disease. Their medical records were evaluated to identify clinical features of postoperative transient COS. The findings on MRI, magnetic resonance angiography, and single-photon emission computed tomography were also analyzed. RESULTS: Transient COS developed in 8 (22.9%) of 35 operated hemispheres, or in 6 (28.6%) of 21 patients between 3 and 20 days after surgery. Most of the COS were associated with mild weakness of the ipsilateral face and hand. Simultaneous radiological studies detected no findings of cerebral infarct or postoperative hyperperfusion. STA-MCA anastomosis was patent in all patients. However, their disease stage more frequently progressed owing to considerable blood flow via STA-MCA anastomosis, and basal moyamoya vessels disappeared or diminished in patients with transient COS rather than in those without. CONCLUSION: Transient COS after surgical revascularization for moyamoya disease is not rare. Bypass flow through STA-MCA anastomosis may stimulate a rapid progression of disease stage and diminish basal moyamoya vessels, causing transient COS within 3 weeks after surgery.

Abstract WP414: Ultrasonographic Changes after Indirect Bypass Surgery in Pediatric Patients with Moyamoya Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shin-Joe Yeh ◽  
Sung-Chun Tang ◽  
Li-Kai Tsai ◽  
Ya-Fang Chen ◽  
Hon-Man Liu ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Pediatric Patients ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Hypoperfusion ◽  
Mean Flow ◽  
Pronounced Increase ◽  
Intracranial Arteries

Background: The marked cerebral hypoperfusion caused by moyamoya disease (MMD) usually manifests as ischemic stroke or transient ischemic attack. The treatment of choice for MMD is extracranial-intracranial bypass surgery; however, the changes of ultrasonographic features following indirect bypass surgery are unknown. This study sought to characterize the ultrasonographic changes that result from indirect bypass surgery in pediatric patients with MMD. Methods: We prospectively recruited 15 pediatric MMD patients who had undergone a total of 19 indirect bypass surgeries (encephaloduroarteriosynangiosis, EDAS) and obtained the relevant clinical and radiological characteristics. Neurovascular ultrasonography of extracranial and intracranial arteries was performed pre-operatively and post-operatively at 1, 3, and 6 months. Results: Among the 15 patients (11 males, 4 females), the mean age was 10.4 ± 4.6 years. Among the extracranial arteries, the superficial temporal artery presented the most pronounced increase in flow velocity and decrease in flow resistance, beginning at 1 month post-op (all p<0.01). Among the large intracranial arteries, a significant increase in mean flow velocity was observed in the anterior cerebral artery since 3 months post-op (p<0.05). Conclusion: Significant hemodynamic changes were observed in pediatric MMD patients after EDAS surgery, as evidenced by periodic ultrasonographic assessment.

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