Abstract
The authors evaluated 25 pediatric patients with moyamoya disease who underwent encephaloduro-arterio-synangiosis (EDAS) for cerebrovascular oligemia. All patients' blood gases were monitored during surgery. Five of the 25 patients developed complications after EDAS. A 19month-old girl had a left-sided hemiconvulsion 14 days postoperatively, followed by left hemiparesis. A 21-month-old girl awoke from anesthesia without apparent problems but later, after persistent crying, developed left hemiparesis. A 27-month-old boy had left hemiparesis preoperatively, which diminished after EDAS. On day 13 after EDAS, an enhanced area in the right frontotemporal cortex was found by computed tomography; 3 months later, the site showed atrophy. A 16year-old girl exhibited slight dysphasia and alexia 4 days after EDAS, and a 17-year-old girl had slight dysarthria for 5 days after EDAS. Patients with and without postoperative problems were compared in terms of steroid usage, preoperative laboratory findings, blood pressure, and intraoperative blood gas profile. There were no significant differences between the two groups. The patients were then assigned to three groups according to age at operation. Patients in Group A were less than 6 years of age, those in Group B 6 to 15 years old, and those in Group C over 15 years of age. Postoperative problems occurred in 3/7 in Group A and 2/3 of Group C, whereas none of the 15 patients in Group B had complications after surgery. The authors recommend that patients with moyamoya disease under age 3 and over age 15 be managed very carefully and that their families be educated regarding the possible sequelae of surgery.
