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Multiple bur hole surgery for the treatment of moyamoya disease in children



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J Neurosurg 6 Suppl Pediatrics 105 437 442 2006 Multiple bur hole surgery for the treatment of moyamoya disease in children CHRISTIAN SAINTE ROSE M D RICARDO OLIVEIRA M D ST PHANIE PUGET M D LIANA BENI ADANI M D NATHALIE BODDAERT M D JOHN THORNE F R C S ALISON WRAY F R A C S MICHEL ZERAH M D AND MARIE BOURGEOIS M D Department of Pediatric Neurosurgery H pital Necker Enfants Malades Paris France and Department of Neurosurgery Royal Children s Hospital Melbourne Australia Object The authors aim in this study was to review their experience in the use of indirect revascularization alone in a series of 14 children with moyamoya disease in which numerous bur holes and arachnoid openings were made over each affected hemisphere Methods Revascularization through multiple bur holes and arachnoid openings was performed in 14 children mean age at diagnosis 6 5 years range 3 15 years who suffered from progressive moyamoya disease The authors performed surgery in a total of 24 hemispheres during 18 procedures Ten children underwent bilateral multiple bur hole procedures three underwent a unilateral procedure in the more severely affected hemisphere and one child had previously undergone an encephaloduroarteriomyosynangiosis on the contralateral side Ten to 24 bur holes were made in the frontotemporoparietooccipital area of each hemisphere depending on the site and extent of the disease Early postoperative perfusion magnetic resonance imaging studies performed in the five most recent cases showed restoration of cortical perfusion as early as 3 months which was confirmed on subsequent angiography studies performed between 8 and 12 months postoperatively that showed excellent revascularization of the ischemic brain by external carotid artery collateral vessels None of the children sustained further ischemic attacks postoperatively Motor improvement was noted in those who had presented with paresis A single seizure episode occurred in two patients at 2 weeks and 5 months after



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