The feasibility of multiple burr hole surgery in pediatric moyamoya disease as a rescue for failed mEDAS

Abstract

Objective: The objective of this study is to prove the feasibility and clinical effectiveness of multi burr-hole surgery(MBS) as a rescue when treating pediatric moyamoya patients with failed mEDAS. Materials and methods: From January 2014 to May 2018, MBS surgery was conducted on 16 hemispheres(12 patients) as a secondary treatment after mEDAS. Male to female ratio was 1:2 and the average age was 6 at the time of mEDAS. Patient age was in average 9±3 year old(range 7-17) at the time of MBS(46 months in average after mEDAS) and 10 holes were made on average. TTP images are divided to 20 axial cuts. Among these 20 axial cuts, two consecutive cuts on the lateral ventricle were selected to calculate the average value because most of holes were made on these two consecutive cuts. The value was modified by subtracting the value of the cerebellum. ROI value was analyzed using a paired t-test by SPSS 20(SPSS Inc., Chicago, IL, USA). Results: All 16 cases presented with clinical symptom improvement. Such effectiveness was proved by ROI analysis of the TTP MRI images. The average of ROI value was 5.03(±6.36) before MBS and -15.54(±9.42) after surgery. The average of changes in ROI value was -20.58(±12.59) and all cases expressed decrease in ROI after MBS surgery. The positive effect of vascularization was also shown on MRA. Conclusion: In pediatric MMD, MBS surgery is recommended as secondary option after the failure of mEDAS. Its clinical effectiveness could be proved by using TTP image and assisted by MRA and DSA.