Angiographic changes after pial synangiosis in childhood moyamoya disease

• Published in: American journal of neuroradiology : AJNR 1997-05, Vol.18 (5), p.837-845
• Main Authors: Robertson, RL, Burrows, PE, Barnes, PD, Robson, CD, Poussaint, TY, Scott, RM
• Format: Article
• Language: English
• Subjects: Adolescent; Biological and medical sciences; Cerebral Angiography; Child; Child, Preschool; Collateral Circulation - physiology; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Male; Medical sciences; Moyamoya Disease - diagnostic imaging; Moyamoya Disease - physiopathology; Moyamoya Disease - surgery; Neurosurgery; Pia Mater - blood supply; Pia Mater - surgery; Postoperative Period; Prognosis; Skull, brain, vascular surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
• ISSN: 0195-6108; 1936-959X

To describe the angiographic changes accompanying the surgical treatment of moyamoya disease by pial synangiosis and to compare these changes with patient outcome. The preoperative and postoperative cerebral angiograms, MR images, and clinical records of 13 children treated with pial synangiosis for moyamoya disease were reviewed. After synangiosis, 10 patients had significant neurologic improvement and three had minimal or no improvement. Postoperative MR images showed no new infarctions. Well-developed (grade A or B) transpial or transdural collaterals to the brain were present at the site of synangiosis in 84% of the surgically treated hemispheres. Cerebrovascular occlusive changes increased postoperatively in 76% of hemispheres. After synangiosis, moyamoya collaterals were increased in 48%, unchanged in 16%, and decreased in 36% of surgically treated hemispheres. All 10 patients with grade A or B collaterals bilaterally after synangiosis were asymptomatic or improved on follow-up. Pial synangiosis typically results in an increase in collaterals from the superficial temporal artery or middle meningeal artery to the brain. Synangiosis appears to result in stabilization or improvement in neurologic symptoms but does not prevent the angiographic progression of disease or the development of moyamoya collaterals. The angiographic demonstration of well-formed collaterals after synangiosis is associated with a favorable clinical outcome.