Kimiwada Tomomi, Hayashi Toshiaki, Shirane Reizo, Tominaga Teiji
1Department of Neurosurgery, Miyagi Children's Hospital.
2Department of Neurosurgery, Sendai City Hospital; and.
J Neurosurg Pediatr. 2018 Jun;21(6):632-638. doi: 10.3171/2018.1.PEDS17367. Epub 2018 Apr 6.
OBJECTIVE Some pediatric patients with moyamoya disease (MMD) present with posterior cerebral artery (PCA) stenosis before and after anterior circulation revascularization surgery and require posterior circulation revascularization surgery. This study evaluated the factors associated with PCA stenosis and assessed the efficacy of posterior circulation revascularization surgery, including occipital artery (OA)-PCA bypass, in pediatric patients with MMD. METHODS The presence of PCA stenosis before and after anterior circulation revascularization surgery and its clinical characteristics were investigated in 62 pediatric patients (< 16 years of age) with MMD. RESULTS Twenty-three pediatric patients (37%) with MMD presented with PCA stenosis at the time of the initial diagnosis. A strong correlation between the presence of infarction and PCA stenosis before anterior revascularization was observed (p < 0.001). In addition, progressive PCA stenosis was observed in 12 patients (19.4%) after anterior revascularization. The presence of infarction and a younger age at the time of initial diagnosis were risk factors for progressive PCA stenosis after anterior revascularization (p < 0.001 and p = 0.002, respectively). Posterior circulation revascularization surgery, including OA-PCA bypass, was performed in 9 of the 12 patients with progressive PCA stenosis, all of whom showed symptomatic and/or radiological improvement. CONCLUSIONS PCA stenosis is an important clinical factor related to poor prognosis in pediatric MMD. One should be aware of the possibility of progressive PCA stenosis during the postoperative follow-up period and consider performing posterior circulation revascularization surgery.
目的 一些患有烟雾病（MMD）的儿科患者在进行前循环血运重建手术前后出现大脑后动脉（PCA）狭窄，需要进行后循环血运重建手术。本研究评估了与PCA狭窄相关的因素，并评估了包括枕动脉（OA）-PCA搭桥术在内的后循环血运重建手术在患有MMD的儿科患者中的疗效。方法 对62例年龄小于16岁的患有MMD的儿科患者进行了前循环血运重建手术前后PCA狭窄的存在情况及其临床特征的调查。结果 23例（37%）患有MMD的儿科患者在初次诊断时出现PCA狭窄。在前循环血运重建前，观察到梗死的存在与PCA狭窄之间存在强烈相关性（p<0.001）。此外，12例患者（19.4%）在前循环血运重建后出现PCA狭窄进展。梗死的存在和初次诊断时年龄较小是前循环血运重建后PCA狭窄进展的危险因素（分别为p<0.001和p = 0.002）。12例PCA狭窄进展的患者中有9例进行了包括OA-PCA搭桥术在内的后循环血运重建手术，所有患者均有症状改善和/或影像学改善。结论 PCA狭窄是儿科MMD预后不良的一个重要临床因素。在术后随访期间应意识到PCA狭窄进展的可能性，并考虑进行后循环血运重建手术。
