Characteristics of periventricular anastomosis after surgical revascularization in pediatric patients with moyamoya disease

Abstract

Most pediatric patients with moyamoya disease have cerebral ischemic symptoms. Surgical revascularization is widely performed to improve the ischemic condition. During the treatment or follow‒up periods, periventricular anastomosis, which is known to be a risk for intracranial hemorrhage, is sometimes observed. In this study, we analyzed the change of periventricular anastomoses after surgical revascularization in pediatric patients with moyamoya disease. This retrospective study included 60 cases of pediatric（younger than 15 years old）patients with moyamoya disease who underwent surgical revascularization for the middle cerebral artery territory. Periventricular anastomoses were evaluated in the images using magnetic resonance angiography. The changes before surgery and at least 3 months after surgery were compared. Lenticulostriate anastomoses were observed in 26 cases before surgery and 4 cases after surgery. Thalamic anastomoses were observed in 23 cases before surgery and 18 cases after surgery. Choroidal anastomoses were observed in 39 cases before surgery and 17 cases after surgery. The periventricular anastomosis score after surgery was significantly higher in cases that showed stenosis or occlusion of the posterior cerebral artery（p＜0.01）, especially if thalamic anastomoses remained（p＜0.01）. In the analysis of 5 cases that showed stenosis or occlusion of the posterior cerebral artery and underwent additional surgical revascularization for the posterior cerebral artery territory, almost all thalamic or choroidal anastomoses decreased after surgery. In pediatric patients with moyamoya disease who show stenosis or occlusion of the posterior cerebral artery, periventricular anastomosis can be prone to remain after surgical revascularization for the middle cerebral artery territory. Surgical revascularization of the posterior cerebral artery territory can contribute to a decrease in periventricular anastomosis.