Appireddy Ramana, Ranjan Manish, Durafourt Bryce A, Riva-Cambrin Jay, Hader Walter J, Adelson P David
1 Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
2 Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA.
J Child Neurol. 2019 Aug;34(9):517-529. doi: 10.1177/0883073819844854. Epub 2019 May 8.
Moyamoya disease is a chronic progressive cerebrovascular occlusive disease of the terminal portion of the internal carotid arteries associated with an acquired abnormal vascular network at the base of the brain, often leading to ischemic or hemorrhagic stroke. Moyamoya disease is a relatively common cause of pediatric stroke with a specific racial and well-identified clinical and imaging phenotype. Moyamoya disease is more prevalent in East Asian countries compared with other geographic regions with a higher incidence of familial cases and clinically more aggressive form. Moyamoya disease is one of the few causes of stroke that is amenable to effective surgical revascularization treatment. There are various surgical options available for revascularization, including the direct, indirect, or combined bypass techniques, each with variable responses. However, due to the heterogeneity of the diseases, different clinical course, geographical variables associated with the disease, and availability of a wide variety of surgical revascularization procedures, optimal selection of a surgical candidate and the surgical technique becomes challenging, particularly in the pediatric population. This brief review presents pertinent literature of clinical options for the diagnosis and surgical treatment of moyamoya disease in children.
烟雾病是一种颈内动脉末端的慢性进行性脑血管闭塞性疾病，伴有脑底部后天形成的异常血管网，常导致缺血性或出血性卒中。烟雾病是儿童卒中相对常见的病因，具有特定的种族以及明确的临床和影像学表型。与其他地理区域相比，烟雾病在东亚国家更为普遍，家族性病例发生率更高，临床形式更具侵袭性。烟雾病是少数可通过有效的外科血管重建治疗的卒中病因之一。有多种用于血管重建的手术选择，包括直接、间接或联合搭桥技术，每种技术的反应各不相同。然而，由于该疾病的异质性、不同的临床病程、与疾病相关的地理变量以及多种外科血管重建手术的可及性，手术候选者和手术技术的最佳选择变得具有挑战性，尤其是在儿科人群中。本简要综述介绍了儿童烟雾病诊断和外科治疗临床选择的相关文献。
