Efficacy of superficial temporal artery-middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease

Object: Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). It is undetermined, however, how rapid increase in CBF affects chronic ischemic brain during the acute stage in childhood moyamoya disease. Materials and methods: The present study includes nine consecutive cases of patients with childhood moyamoya disease (2∼8 years old, 6.2 in average), who underwent superficial temporal artery - middle cerebral artery (STA-MCA) anastomosis on 17 hemispheres. We prospectively performed single-photon emission computed tomography 1 and 7 days after 17 surgeries. The follow-up period ranged from 12 to 37 months (24.9 in average). Results: The outcome of 17 surgeries was excellent (disappearance of transient ischemic attack) in 14 hemispheres (82.4%) and good (reduction of transient ischemic attack) in three hemispheres (17.6%). No patient suffered peri-operative infarction, except for one (5.9%) manifesting as pseudolaminar necrosis in a part of the cerebral cortex supplied by STA-MCA bypass at the subacute stage, which did not affect his long-term neurological status. One patient (5.9%) presented with transient facial palsy due to hyperperfusion, which resolved within several days. No patient manifested permanent neurological deterioration during the follow-up period. Conclusion: The STA-MCA anastomosis is a safe and effective treatment for childhood moyamoya disease. We recommend routine CBF measurement for avoiding surgical complications including both cerebral ischemia and hyperperfusion.