Delayed posterior circulation insufficiency in pediatric moyamoya disease View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-09-12

AUTHORS

Ji Yeoun Lee, Young-Hun Choi, Jung-Eun Cheon, Jin Chul Paeng, Hye Won Ryu, Ki Joong Kim, Ji Hoon Phi, Kyu-Chang Wang, Byung-Kyu Cho, Jong-Hee Chae, Seung-Ki Kim

ABSTRACT

Approximately 30 % of patients with moyamoya disease (MMD) have presented with involvement of the posterior circulation, mainly the posterior cerebral artery (PCA). Diagnosis of delayed progression of PCA stenosis in MMD may be difficult due to the diversity in clinical features. The goal of this study was to evaluate pediatric MMD patients with delayed PCA involvement after completion of revascularization of the anterior circulation. Forty-one pediatric MMD patients who underwent revascularization of the PCA territory due to delayed posterior circulation insufficiency MMD from 2006 to 2011 were retrospectively reviewed. The average interval between the initial operation and the occipital artery (OA) procedure was 5.0 years. Common symptoms were headaches and transient visual symptoms. The decision to operate was made based on a combination of diagnostic tools. The results obtained with perfusion MRI, SPECT, MR angiography, and EEG supported posterior circulation insufficiency in 78, 41, 73, and 71 % of patients, respectively. Encephaloduroarteriosynangiosis (EDAS) using the OA was performed in 15 patients, and 26 patients received multiple burr hole trephination of the occipital area. All patients showed clinical improvement. Clinicians should be aware of the possibility of delayed involvement of the PCA in pediatric MMD patients. The clinical decision regarding treatment should be based on a combination of symptomatology and the results obtained with various tools to assess whether the blood flow in the PCA territory is insufficient. Surgical treatment using indirect revascularization appears to be effective for patients with delayed PCA involvement. More... »

PAGES

2305-2313

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00415-014-7484-7

DOI

http://dx.doi.org/10.1007/s00415-014-7484-7

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1036629029

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25212285


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32 schema:description Abstract Approximately 30 % of patients with moyamoya disease (MMD) have presented with involvement of the posterior circulation, mainly the posterior cerebral artery (PCA). Diagnosis of delayed progression of PCA stenosis in MMD may be difficult due to the diversity in clinical features. The goal of this study was to evaluate pediatric MMD patients with delayed PCA involvement after completion of revascularization of the anterior circulation. Forty-one pediatric MMD patients who underwent revascularization of the PCA territory due to delayed posterior circulation insufficiency MMD from 2006 to 2011 were retrospectively reviewed. The average interval between the initial operation and the occipital artery (OA) procedure was 5.0 years. Common symptoms were headaches and transient visual symptoms. The decision to operate was made based on a combination of diagnostic tools. The results obtained with perfusion MRI, SPECT, MR angiography, and EEG supported posterior circulation insufficiency in 78, 41, 73, and 71 % of patients, respectively. Encephaloduroarteriosynangiosis (EDAS) using the OA was performed in 15 patients, and 26 patients received multiple burr hole trephination of the occipital area. All patients showed clinical improvement. Clinicians should be aware of the possibility of delayed involvement of the PCA in pediatric MMD patients. The clinical decision regarding treatment should be based on a combination of symptomatology and the results obtained with various tools to assess whether the blood flow in the PCA territory is insufficient. Surgical treatment using indirect revascularization appears to be effective for patients with delayed PCA involvement.
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39 MMD patients
40 MR angiography
41 MRI
42 OA
43 PCA involvement
44 PCA stenosis
45 PCA territory
46 SPECT
47 angiography
48 anterior circulation
49 area
50 artery
51 average interval
52 blood flow
53 cerebral artery
54 circulation
55 circulation insufficiency
56 clinical decision
57 clinical features
58 clinical improvement
59 clinicians
60 combination
61 combination of symptomatology
62 common symptoms
63 completion
64 decisions
65 diagnosis
66 diagnostic tool
67 disease
68 diversity
69 encephaloduroarteriosynangiosis
70 features
71 flow
72 goal
73 headache
74 hole trephination
75 improvement
76 indirect revascularization
77 initial operation
78 insufficiency
79 interval
80 involvement
81 moyamoya disease
82 occipital areas
83 operation
84 patients
85 pediatric MMD patients
86 pediatric moyamoya disease
87 perfusion MRI
88 possibility
89 posterior cerebral artery
90 posterior circulation
91 posterior circulation insufficiency
92 procedure
93 progression
94 results
95 revascularization
96 stenosis
97 study
98 surgical treatment
99 symptomatology
100 symptoms
101 territory
102 tool
103 transient visual symptoms
104 treatment
105 trephination
106 visual symptoms
107 years
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