Superficial temporal artery-middle cerebral artery bypass combined with encepho-dural-myo-pericranio-synangiosis for preschool children with moyamoya disease

WANG Dong; JIAO Yong-hui; SHEN Jun-feng; JIN Yong-jian

doi:10.3969/j.issn.1672-6731.2025.10.014

Abstract：Objective To explore the safety and feasibility of superficial temporal artery(STA)-middle cerebral artery(MCA)bypass combined encepho-dural-myo-pericranio-synangiosis(EDMPS)in the treatment of moyamoya disease(MMD)in preschool children(≤6 years old).Methods The clinical data of 18 preschool children with MMD treated with STA-MCA+EDMPS surgery at Aviation General Hospital from January 2017 to December 2019 were analyzed.Postoperative one week CTA 3D reconstruction and CT perfusion(CTP)were performed to evaluate the scope of craniotomy,the patency of bypass vessels and improvement of ischemic cerebral tissue perfusion.Postoperative 6 months CT or MRI was performed to evaluate the new ischemic stroke or intracerebral hemorrhage,and CTA or DSA was performed 12 months after the operation to evaluate the patency of bypass vessels.The modified Rankin Scale(mRS)was used to evaluate the patients'neurological recovery.Results The surgeries on 31 hemispheres of 18 patients were successfully completed.Postoperative one week CTA showed that the bypass vessel was unobstructed.Postoperative one week MRI of one case(Case 9)showed asymptomatic small-area cerebral infarction.All 4 patients who had transient ishchemic attack(TIA)symptoms before surgery had their symptoms disappear after surgery.Only one case(Case 3)developed TIA.One case(Case 17)developed contralateral new ischemic stroke while waiting for contralateral surgery after the first postoperative operation(3-6 months).The follow-up time of 18 patients was(57.28±13.32)months.The new ischemic stroke or intracerebral hemorrhage was no observed in postoperative 6 months.Postoperative 12 months CTA or DSA showed that the STA-MCA bypass unobstructed in 26 sides of 13 patients and not visualized in 5 sides of 5 patients.Collateral vessels due to indirect revascularization were visible in all 18 patients.By the end of the follow-up,the median mRS score was 1.00(0.25,1.75).None of the children patients presented with ischemic or hemorrhagic stroke events,cerebral hyperperfusion syndrome(CHS),TIA,epileptic seizure,cognitive dysfunction or poor incision healing.Conclusions Using STA-MCA+EDMPS to treat preschool children with MMD can not only quickly improve the blood supply of ischemic brain tissue,but also achieve a larger range of indirect revascularization.It is safe and feasible,and has good long-term follow-up results.