Effect of Multiple Cranial Burr Hole Surgery on Prevention of Recurrent Ischemic Attacks in Children with Moyamoya Disease

R. S. de Oliveira; M. C. M. Amato; G. N. Simão; D. G. Abud; E. B. Avidago; C. M. Specian; H. R. Machado

doi:10.1055/s-0030-1249069

Neuropediatrics, Table of Contents

Neuropediatrics 2009; 40(6): 260-264
DOI: 10.1055/s-0030-1249069

Original Article

Effect of Multiple Cranial Burr Hole Surgery on Prevention of Recurrent Ischemic Attacks in Children with Moyamoya Disease

R. S. de Oliveira¹ , M. C. M. Amato¹ , G. N. Simão² , D. G. Abud² , E. B. Avidago³ , C. M. Specian³ , H. R. Machado¹

¹Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, Brazil
²Division of Radiology, Ribeirão Preto School of Medicine, São Paulo University, Ribeirão Preto, Brazil
³Division of Pediatric Neurosurgery, Hospital PIO XII, São José dos Campos, Brazil

Abstract

Moyamoya disease (MMD) is an uncommon cerebrovascular disorder characterized by progressive stenosis of the terminal portion of the internal carotid artery and its main branches. Direct and indirect bypass techniques have been devised with the aim of promoting neoangiogenesis. The current study aimed to investigate the role of multiple cranial burr hole (MCBH) operations in the prevention of cerebral ischemic attacks in children with MMD. Seven children suffering from progressive MMD were submitted to the MCBH and arachnoid opening technique. Ten to 20 burr holes were drilled in the fronto-temporo-parieto-occipital area of each hemisphere in each patient, depending on the site and extent of the disease. All patients were evaluated pre- and postoperatively by means of Barthel index (BI), CT, MR, angio-MR, and angiography. Patients had no recurrence of ischemic attacks postoperatively. Neoangiogenesis was observed in both hemispheres. One patient developed a persistent subdural collection after surgery, thus requiring placement of a subdural-peritoneal shunt. Postoperative BI was statistically significantly improved (P=0.02). This report suggests that MCBH for revascularization in MMD is a simple procedure with a relatively low risk of complications and effective for preventing cerebral ischemic attacks in children. In addition, MCBH may be placed as an adjunct to other treatments for MMD.

Key words

moyamoya disease - multiple cranial burr holes - indirect revascularization - pediatric neurosurgery

Full Text

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Correspondence

Ricardo Santos de OliveiraMD, PhD

Divisão de Neurocirurgia

Pediátrica

Departamento de Cirurgia e

Anatomia

Faculdade de Medicina de

Ribeirão Preto da Universidade

de São Paulo

14049-900 Ribeirão Preto

Brazil

Phone: +55/16/360 22613

Fax: +55/16/363 30836

Email: rsoliveira@hcfmrp.usp.br