Revascularisation surgery for paediatric moyamoya disease: The Singapore experience. (December 2020)

• Record Type: Journal Article
• Authors: Ong, Jamie AH; Low, Sharon YY; Seow, Wan Tew; Goh, Chun Peng; Yeo, Tseng Tsai; Chou, Ning; Low, David CY; Nga, Vincent
• Is Part Of: Journal of clinical neuroscience. Volume 82:Part B(2020)
• Page Start: 207
• Page End: 213
• Publication Date: 2020-12
• Subjects: Paediatric moyamoya disease -- Revascularisation; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.11.008
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Paediatric moyamoya disease (MMD) is a significant contributor to childhood stroke. There is currently no standardized surgical approach for paediatric MMD. We aim to review the revascularization outcomes of paediatric MMD in Singapore. Salient points from the study are discussed in corroboration with literature. Abstract: Moyamoya disease (MMD) is characterized by the spontaneous occlusion of the distal internal carotid arteries and resultant neo-angiogenesis of fragile collateral blood vessels. Direct and indirect revascularization surgeries have shown to effectively reduce stroke risks in paediatric MMD, whereby the latter is a more utilised technique in children. This study was undertaken to determine the outcomes of revascularization in Singapore's multi-ethnic, Southeast Asian paediatric population. This is an ethics-approved study conducted in Singapore's 2 tertiary children hospital units: KK Women's and Children's Hospital and National University Hospital. Sixteen patients with a diagnosis of ischaemic-type MMD are recruited between 01 January 2002 to 31 January 2019; and a total of 24 surgeries are undertaken (24 cerebral hemispheres). There are 2 cases of stroke within 30 days post-surgery. However, no stroke recurrence is observed beyond 30 days after surgery in all patients. Four patients reported recurrent transient ischaemic attack symptoms in the follow-up period ranging from 3 months to 12 years. Data analyses show a statistically significant improvement in modified Rankin's Scale (mMRS) in post-operative patients from baseline to discharge, and at 3 months after surgery. Our study also observes that predictors of recurrent ischaemic events include higher pre-operative MRS, Suzuki stage and perioperative infarction. To the authors' knowledge, this is the first study to date reporting the outcomes of revascularisation in a paediatric Southeast Asian cohort.