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The feasibility of performing multiple burr hole surgery in pediatric moyamoya patients as a response to failed mEDAS

Authors
 Jun Kyu Hwang  ;  Eun Kyung Park  ;  Jinna Kim  ;  Hoon-Chul Kang  ;  Dong-Seok Kim  ;  Kyu-Won Shim 
Citation
 CHILDS NERVOUS SYSTEM, Vol.37(7) : 2233-2238, 2021-07 
Journal Title
CHILDS NERVOUS SYSTEM
ISSN
 0256-7040 
Issue Date
2021-07
MeSH
Angiography, Digital Subtraction ; Cerebral Revascularization* ; Child ; Feasibility Studies ; Female ; Humans ; Infant ; Male ; Moyamoya Disease* / diagnostic imaging ; Moyamoya Disease* / surgery ; Trephining
Keywords
Moyamoya disease ; Revascularization ; Time to peak map
Abstract
Objective: To investigate the feasibility and clinical effectiveness of performing multiple burr hole surgery in pediatric moyamoya patients as a response to failed modified encephaloduroarteriosynangiosis (mEDAS).

Methods: From January 2014 to May 2018, multiple burr hole surgery (MBS) was conducted on 16 hemispheres in 12 patients as a secondary treatment following mEDAS. The male-to-female ratio was 1:2 and the average age at the time of mEDAS was 6 years old. The average patient age was 9 ± 3 years olds (range 7-17) at the time of MBS which occurred an average of 46 months after mEDAS. An average of 10 ± 1 holes (range 8-13) were made. Time-to-peak (TTP) magnetic resonance images (MRI) were taken along 20 axial cuts. Of these cuts, two consecutive cuts on the lateral ventricle were selected to calculate the average value of the region of interest (ROI). The value of the cerebellum was subtracted from the average value of two consecutive cuts. The ROI value was analyzed using a paired t test by SPSS 20 (SPSS Inc., Chicago, IL, USA).

Results: All 16 cases presented improvement of clinical symptoms as determined by ROI analysis of the TTP MRI images. The average ROI value was 5.03 ± 6.36 before MBS and - 15.54 ± 9.42 after MBS. The average change in the ROI value was - 20.58 ± 12.59. The ROI value decreased in all cases after MBS. Magnetic resonance angiography (MRA) also showed a positive effect on vascularization.

Conclusion: In pediatric moyamoya patients, MBS is recommended as secondary option as a response to failed mEDAS. Its clinical effectiveness was shown by analyzing TTP images and assisted by MRA and digital subtraction angiography.
Full Text
https://link.springer.com/article/10.1007%2Fs00381-021-05093-z
DOI
10.1007/s00381-021-05093-z
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Hoon Chul(강훈철) ORCID logo https://orcid.org/0000-0002-3659-8847
Kim, Dong Seok(김동석)
Park, Eun Kyung(박은경)
Shim, Kyu Won(심규원) ORCID logo https://orcid.org/0000-0002-9441-7354
Hwang, Jun Kyu(황준규)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186985
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