Combined Encephaloduroarteriosynangiosis and Bifrontal Encephalogaleo(periosteal)synangiosis in Pediatric Moyamoya Disease

Neurosurgery ◽  
2002 ◽  
Vol 50 (1) ◽  
pp. 88-96 ◽  
Author(s):  
Seung-Ki Kim ◽  
Kyu-Chang Wang ◽  
In-One Kim ◽  
Dong Soo Lee ◽  
Byung-Kyu Cho
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Single Photon ◽  
Photon Emission ◽  
Single Photon Emission ◽  
Computed Tomographic ◽  
Group A ◽  
Single Photon Emission Computed ◽  
Group B

ABSTRACT OBJECTIVE We compared the surgical results of simple encephaloduroarteriosynangiosis (EDAS) and EDAS with bifrontal encephalogaleo(periosteal)synangiosis for the treatment of pediatric moyamoya disease. METHODS Data for 159 children (up to 15 yr of age, 76 boys and 83 girls) who underwent indirect revascularization procedures for the treatment of moyamoya disease between 1987 and 1998 were retrospectively reviewed. Group A patients underwent simple EDAS (n = 67). Group B patients underwent EDAS with bifrontal encephalogaleo(periosteal)synangiosis (n = 92). The surgical results for each group were compared, in terms of clinical outcomes, neuroimaging changes, extent of revascularization evident on angiograms, and hemodynamic changes evident on single-photon emission computed tomographic scans. The average follow-up periods were 45 months for Group A and 22 months for Group B. RESULTS The overall clinical outcomes and neuroimaging changes tended to be better for Group B. In terms of single-photon emission computed tomographic changes of the whole brain after surgery, Group B patients exhibited more favorable outcomes than did Group A patients (62 versus 36%, P = 0.003). The surgical results for the anterior cerebral artery territory were significantly better for Group B than for Group A, with respect to outcomes of anterior cerebral artery symptoms (81 versus 40%, P = 0.015), revascularization on angiograms (79 versus 16%, P < 0.001), and hemodynamic changes on single-photon emission computed tomographic scans (70 versus 52%, P = 0.002). The incidences of postoperative infarctions were not significantly different between the two groups. CONCLUSION EDAS with bifrontal encephalogaleo(periosteal)synangiosis is a more effective surgical modality for the treatment of pediatric moyamoya disease, compared with simple EDAS, because it covers both the middle cerebral artery and anterior cerebral artery territories of the brain.

A Case of Organic Mania Associated with Open Heart Surgery

1994 ◽  
Vol 7 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Kathryn J. Kotrla ◽  
Ranjit C. Chacko ◽  
Shawn A. Barrett
Keyword(s):  
Heart Surgery ◽  
Single Photon ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Photon Emission ◽  
Open Heart Surgery ◽  
Brain Regions ◽  
Single Photon Emission ◽  
Computed Tomographic ◽  
Single Photon Emission Computed

Organic mania has been reported to have multiple etiologies. A case is described of a patient who developed mania following a coronary artery bypass graft and mitral valve replacement. Cerebral abnormalities were not detected by computed tomographic or magnetic resonance imaging scans, but an area of dysfunction was found using single photon emission computed tomographic (SPECT) imaging. The lesion resolved when the patient became clinically asymptomatic. The area of decreased cerebral perfusion associated with the patient's mania was in an atypical location, raising questions about which brain regions can result in well-defined psychiatric syndromes.

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