The First Two Post-EDAS Pediatric Moyamoya Patients who Have Had Encephalo-duro-arterio-synangiosis for More Than 10 Years

Abstract

We report here on a 10-year follow-up study of two Moyamoya children who underwent an indirect EC-IC bypass operation of encephalo-duro-arterio-synangiosis.
Case 1 was 8 years old at the time of the first operation and he now is a 20-year-old post-office clerk. Case 2 was 11 years old at the time of EDAS and he is now a 22-year-old university student at a law school.
Case 1 was a TIA type patient and Case 2 was a TIA-infarction type moyamoya patient at the time of the operation. The clinical symptoms of ischemic attacks that they had had rather frequently before the operations disappeared within three months after the operation and recurrence has not been seen since. Postoperative WISC or WAIS scores of both patients have been maintained within normal limits.
Angiography revealed substantial anastomoses between transplanted donor arteries and cortical arteries as if the brain feeders had been replaced by the external carotid arterial system. Moyamoya vessels observed preoperatively decreased much in both cases.
Cerebral blood flow was measured by means of Xenon enhanced CT and it was revealed that the resting CBF was slightly decreased generally but vascular reserve capacity was abundant in Case 1 and that resting CBF was quite normal but vascular reserve capacity was rather decreased in Case 2.
Clinical status in these two cases and natural progress of the non-operated Moyamoya cases were compared based on papers published in the past, and we concluded that our operation EDAS performed on the two cases was effective in modifying their clinical progress.