Combined direct and indirect revascularization surgery for pediatric moyamoya disease using plastic surgical techniques

• Published in: Nervous System in Children Vol. 46; no. 4; pp. 284 - 289
• Main Authors: Yoshikane, Tsutomu, Hayashi, Kentaro, Yamamoto, Kazuhiro, Uchimura, Masahiro, Fujiwara, Yuta, Nakagawa, Fumio, Kambara, Mizuki, Nagai, Hidemasa, Akiyama, Yasuhiko
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Pediatric Neurosurgery 2021
• Subjects: aesthetic surgical techniques; combined vascular reconstruction; moyamoya disease
• ISSN: 0387-8023; 2435-824X
• DOI: 10.34544/jspn.46.4_284

Introduction: A combination of direct and indirect revascularization surgery is performed in Japanese modern neurosurgery. However, some disadvantages of this method include thinning of temporal components, delay in bone flap fusion, and metal plate denudation. Moreover, an aesthetic problem of this surgery is that serious complications may occur in children who have a long postoperative life. In this study, we report our plastic surgical techniques for treating pediatric patients with moyamoya disease.Patients and Methods: This retrospective study included four children (six brain hemispheres) with moyamoya disease who underwent our combined revascularization surgery from November 2017 to March 2020. This combined revascularization surgery is characterized by less use of bipolar coagulation at a skin incision and superficial temporal artery dissection, splitting temporal muscle between deep and superficial layers, incision design of the bone flap to prevent it from sinking, and employment of an absorbable material for bone flap fixation and skin suture.Result: The postoperative course was uneventful and good revascularization was achieved in all patients. Neither thinning nor depression was observed in temporal components.Conclusions: Combined revascularization surgery for pediatric moyamoya disease has a risk of cosmetic problem. Our craniotomy and cranioplasty techniques were effective for revascularization and preventing cosmetic problems.