TY - JOUR
T1 - Wide Arterial Sparing Encephalo-Duro-Synangiosis for Moyamoya
T2 - Surgical Technique and Outcomes
AU - Dawkins, Demi
AU - Aagaard-Kienitz, Beverly
AU - Capel, Kelly
AU - Eisenmenger, Laura
AU - Samsonov, Alexey
AU - Li, Yiping
AU - Sandoval-Garcia, Carolina
AU - Iskandar, Bermans
N1 - Publisher Copyright:
Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
PY - 2022/12/16
Y1 - 2022/12/16
N2 - BACKGROUND: Moyamoya is managed by surgical revascularization, but no standardized method has yet been universally adopted. OBJECTIVE: To describe a new indirect bypass technique for pediatric moyamoya, wide arterial sparing encephalo-duro-synangiosis (WASEDS), which provides a much wider area of revascularization with minimal compromise to the middle meningeal arterial tree compared with traditional procedures. Initially used as a salvage technique after failed encephalo-duro-arterio-synangiosis, its success later motivated its use as a first-line procedure. METHODS: Clinical and radiographic records of patients who underwent WASEDS for moyamoya from 2009 to 2020 were reviewed. Brain perfusion relative cerebral blood volume on the side of the WASEDS procedure was calculated. Two-tailed paired t tests were performed to identify the statistically significant differences (P ≤ .05). RESULTS: WASEDS was successfully performed on 8 patients for a total of 14 cerebral hemispheres. Age ranged from 2 to 25 years. There were no mortalities. The average clinical and radiographic follow-up was 49.79 months (range 2-126 months), demonstrating improvement in neurological condition and no postoperative stroke and significant diminution or cessation of transient ischemic attacks in all patients. Relative cerebral blood volume increased 9.24% after the WASEDS procedure (P = .012). There were no neurological complications. There were 2 pseudomeningoceles related to the extensive dural openings. CONCLUSION: WASEDS is a safe and effective indirect revascularization technique for both primary and salvage techniques. It provides an extensive area of cortical revascularization with no compromise of the middle meningeal vasculature and subjective reports of early improvement in cognition and behavior. The main disadvantage is elevated risk of pseudomeningocele secondary to the large craniotomy.
AB - BACKGROUND: Moyamoya is managed by surgical revascularization, but no standardized method has yet been universally adopted. OBJECTIVE: To describe a new indirect bypass technique for pediatric moyamoya, wide arterial sparing encephalo-duro-synangiosis (WASEDS), which provides a much wider area of revascularization with minimal compromise to the middle meningeal arterial tree compared with traditional procedures. Initially used as a salvage technique after failed encephalo-duro-arterio-synangiosis, its success later motivated its use as a first-line procedure. METHODS: Clinical and radiographic records of patients who underwent WASEDS for moyamoya from 2009 to 2020 were reviewed. Brain perfusion relative cerebral blood volume on the side of the WASEDS procedure was calculated. Two-tailed paired t tests were performed to identify the statistically significant differences (P ≤ .05). RESULTS: WASEDS was successfully performed on 8 patients for a total of 14 cerebral hemispheres. Age ranged from 2 to 25 years. There were no mortalities. The average clinical and radiographic follow-up was 49.79 months (range 2-126 months), demonstrating improvement in neurological condition and no postoperative stroke and significant diminution or cessation of transient ischemic attacks in all patients. Relative cerebral blood volume increased 9.24% after the WASEDS procedure (P = .012). There were no neurological complications. There were 2 pseudomeningoceles related to the extensive dural openings. CONCLUSION: WASEDS is a safe and effective indirect revascularization technique for both primary and salvage techniques. It provides an extensive area of cortical revascularization with no compromise of the middle meningeal vasculature and subjective reports of early improvement in cognition and behavior. The main disadvantage is elevated risk of pseudomeningocele secondary to the large craniotomy.
KW - Direct bypass
KW - Encephalo-duro-synangiosis
KW - Indirect bypass
KW - Moyamoya
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U2 - 10.1227/ons.0000000000000376
DO - 10.1227/ons.0000000000000376
M3 - Article
C2 - 36113163
AN - SCOPUS:85142401012
SN - 2332-4252
VL - 23
SP - 489
EP - 498
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 6
ER -