Encephaloduroarteriosynangiosis with Dural Inversion for Moyamoya Disease in a Pediatric and Adult Population-a Single-Center 20-Year Experience.
Adolescent
Adult
Cerebral Infarction
/ epidemiology
Cerebral Revascularization
/ methods
Child
Child, Preschool
Female
Functional Status
Hemorrhagic Stroke
/ epidemiology
Humans
Infant
Ischemic Stroke
/ epidemiology
Male
Middle Aged
Moyamoya Disease
/ physiopathology
Neurosurgical Procedures
/ methods
Patient Satisfaction
Postoperative Complications
/ epidemiology
Treatment Outcome
Young Adult
Encephaloduroarteriosynangiosis
Moyamoya disease
Surgery
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
01
01
2021
revised:
20
02
2021
accepted:
21
02
2021
pubmed:
2
3
2021
medline:
12
8
2021
entrez:
1
3
2021
Statut:
ppublish
Résumé
Moyamoya disease refers to a progressive vasostenotic or vaso-occlusive disease that puts patients at risk for ischemic and/or hemorrhagic events. Surgical revascularization procedures aim to restore cerebral blood flow to mitigate stroke risk and functional decline. Direct and indirect bypass procedures have been proposed. Encephaloduroarteriosynangiosis (EDAS) with dural inversion is a well-accepted indirect procedure. Patients with moyamoya disease undergoing EDAS with dural inversion between 2000 and 2019 were retrospectively reviewed. Clinical data including short-term and long-term outcome were measured using the modified Rankin Scale. Patient satisfaction was assessed in patients with a minimum of 3 years of clinical follow-up. Over a 20-year period, 54 patients underwent 88 EDAS with dural inversion procedures. Most patients underwent bilateral surgery (34/54 patients, 63.0%). Median age at surgery was 19 years (range, 1-63 years) with a median follow-up of 6 years (range, 1-20 years). Periprocedural complications occurred in 4 of 54 patients (7.4%). Periprocedural infarction occurred in 3 of 88 operations (3.4%). Functional outcome at 90 days was favorable (modified Rankin Scale score 0-2) in 92.6% of cases. On long-term follow-up, 3 patients experienced ischemic infarction (5.6%), and 1 patient (1.9%) experienced hemorrhagic infarction. Patients' overall satisfaction with the surgical procedure at last follow-up was determined in 36 of 45 patients with at least 3 years of follow-up (response rate 80.0%). Median satisfaction was very good (score 5; range, 3-5). EDAS with dural inversion is a safe and effective indirect revascularization procedure for pediatric and adult moyamoya disease that is associated with favorable long-term outcomes and high patient satisfaction.
Sections du résumé
BACKGROUND
Moyamoya disease refers to a progressive vasostenotic or vaso-occlusive disease that puts patients at risk for ischemic and/or hemorrhagic events. Surgical revascularization procedures aim to restore cerebral blood flow to mitigate stroke risk and functional decline. Direct and indirect bypass procedures have been proposed. Encephaloduroarteriosynangiosis (EDAS) with dural inversion is a well-accepted indirect procedure.
METHODS
Patients with moyamoya disease undergoing EDAS with dural inversion between 2000 and 2019 were retrospectively reviewed. Clinical data including short-term and long-term outcome were measured using the modified Rankin Scale. Patient satisfaction was assessed in patients with a minimum of 3 years of clinical follow-up.
RESULTS
Over a 20-year period, 54 patients underwent 88 EDAS with dural inversion procedures. Most patients underwent bilateral surgery (34/54 patients, 63.0%). Median age at surgery was 19 years (range, 1-63 years) with a median follow-up of 6 years (range, 1-20 years). Periprocedural complications occurred in 4 of 54 patients (7.4%). Periprocedural infarction occurred in 3 of 88 operations (3.4%). Functional outcome at 90 days was favorable (modified Rankin Scale score 0-2) in 92.6% of cases. On long-term follow-up, 3 patients experienced ischemic infarction (5.6%), and 1 patient (1.9%) experienced hemorrhagic infarction. Patients' overall satisfaction with the surgical procedure at last follow-up was determined in 36 of 45 patients with at least 3 years of follow-up (response rate 80.0%). Median satisfaction was very good (score 5; range, 3-5).
CONCLUSIONS
EDAS with dural inversion is a safe and effective indirect revascularization procedure for pediatric and adult moyamoya disease that is associated with favorable long-term outcomes and high patient satisfaction.
Identifiants
pubmed: 33647488
pii: S1878-8750(21)00295-3
doi: 10.1016/j.wneu.2021.02.102
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e16-e21Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.