From the Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
From the Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
AJNR Am J Neuroradiol. 2021 Jun;42(6):1157-1162. doi: 10.3174/ajnr.A7059. Epub 2021 Mar 18.
In certain cases of pediatric patients with Moyamoya disease undergoing encephaloduroarteriosynangiosis (EDAS) treatment, the posterior auricular artery can be used as an alternative when the parietal branch of the superficial temporal artery is unavailable. In this study, anatomic variations of the superficial temporal and posterior auricular arteries in pediatric patients with Moyamoya disease and postoperative outcomes of posterior auricular artery-EDAS are explored.
Medical records of 572 patients with Moyamoya disease who underwent surgical procedures from 2007 to 2017 at the Seoul National University Children's Hospital were reviewed. Anatomic classifications of the superficial temporal and posterior auricular arteries were based on previous classifications. Postoperative hemodynamic changes of posterior auricular artery-EDAS were analyzed using the Matsushima grade. Also, Karnofsky Performance Scale and mRS scores of posterior auricular artery-EDAS cases were reviewed to identify postoperative clinical outcomes.
Among 1144 hemispheres, 24 were considered posterior auricular artery-EDAS candidates (2.1%). Of those, 10 hemispheres underwent posterior auricular artery-EDAS (41.7%, in total hemispheres 0.9%). Comparing the Matsushima grades of the superficial temporal artery-EDAS and posterior auricular artery-EDAS groups showed similar postoperative revascularization. Postoperative Karnofsky Performance Scale and mRS scores of patients having undergone posterior auricular artery-EDAS did not show deterioration.
In approximately 2% of pediatric patients with Moyamoya disease for whom the superficial temporal artery is unavailable as the EDAS donor, the posterior auricular artery can be considered an alternative. On the basis of the results, the clinical outcome of posterior auricular artery-EDAS was not inferior to that of superficial temporal artery-EDAS. Hence, we suggest an in-depth consideration of the posterior auricular artery as the donor artery if the superficial temporal artery parietal branch is unavailable.
在某些儿童烟雾病患者行颅内外血管搭桥术（EDAS）治疗的情况下，如果颞浅动脉顶支无法使用，可以选择使用耳后动脉作为替代血管。本研究旨在探讨儿童烟雾病患者颞浅动脉和耳后动脉的解剖变异，以及耳后动脉-EDAS 的术后结果。
回顾了 2007 年至 2017 年期间在首尔国立大学儿童医院行手术治疗的 572 例烟雾病患者的病历。根据既往分类方法对颞浅动脉和耳后动脉进行解剖分类。采用松田分级分析耳后动脉-EDAS 的术后血流动力学变化。还回顾了耳后动脉-EDAS 病例的卡氏行为状态量表（Karnofsky Performance Scale）和 mRS 评分，以确定术后临床结果。
在 1144 个半脑中，有 24 个被认为是耳后动脉-EDAS 候选者（2.1%）。其中，10 个半脑进行了耳后动脉-EDAS（总共半脑的 0.9%）。比较颞浅动脉-EDAS 组和耳后动脉-EDAS 组的松田分级，显示术后再血管化相似。行耳后动脉-EDAS 患者的术后卡氏行为状态量表和 mRS 评分未出现恶化。
在约 2%的因颞浅动脉作为 EDAS 供体不可用而无法接受治疗的儿童烟雾病患者中，可以考虑使用耳后动脉作为替代血管。基于这些结果，耳后动脉-EDAS 的临床结果并不逊于颞浅动脉-EDAS。因此，如果颞浅动脉顶支无法使用，我们建议深入考虑将耳后动脉作为供体动脉。
