Postoperative Cerebral Infarction Risk Factors and Postoperative Management of Pediatric Patients with Moyamoya Disease.

Abstract

OBJECTIVE:

Although revascularization surgery for patients with moyamoya disease can effectively prevent ischemic events and thus improve the long-term clinical outcome, the incidence of postoperative ischemic complications affects patients' quality of life. This study aimed to clarify the risk factors associated with postoperative ischemic complications and to discuss the appropriate perioperative management.

METHODS:

Fifty-eight revascularization operations were performed in 37 children with moyamoya disease. Patients with moyamoya syndrome were excluded from this study. Magnetic resonance imaging was performed within 7 days after surgery. Postoperative cerebral infarction was defined as a diffusion-weighted imaging high-intensity lesion with or without symptoms. We usually use fentanyl and dexmedetomidine as postoperative analgesic and sedative drugs for patients with moyamoya disease. We used barbiturate coma therapy for pediatric patients with moyamoya disease who have all postoperative cerebral infarction risk factors.

RESULTS:

Postoperative ischemic complications were observed in 10.3% of the children with moyamoya disease (6 of 58). Preoperative cerebral infarctions (P = 0.0005), younger age (P = 0.038), higher Suzuki grade (P = 0.003), and posterior cerebral artery stenosis/occlusion (P = 0.003) were related to postoperative ischemic complications. Postoperative cerebral infarction occurred all pediatric patients using barbiturate coma therapy.

CONCLUSIONS:

The risk factors associated with postoperative ischemic complications for children with moyamoya disease are preoperative infarction, younger age, higher Suzuki grade, and posterior cerebral artery stenosis/occlusion. Barbiturate coma therapy for pediatric patients with moyamoya disease who have the previous risk factors is insufficient for prevention of postoperative cerebral infarction. More studies are needed to identify the appropriate perioperative management.

• Authors: Shinsuke Muraoka, Yoshio Araki, Goro Kondo, Michihiro Kurimoto, Yoshiki Shiba, Kenji Uda, Shinji Ota, Sho Okamoto, Toshihiko Wakabayashi
• Journal: World neurosurgery (World Neurosurg) Vol. 113 Pg. e190-e199 (May 2018) ISSN: 1878-8769 [Electronic] United States
• PMID: 29432946 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Chemical References

• Analgesics
• Barbiturates
• Hypnotics and Sedatives
• Dexmedetomidine
• Fentanyl

Topics

• Adolescent
• Analgesics (therapeutic use)
• Barbiturates (therapeutic use)
• Cerebral Infarction (etiology, prevention & control, therapy)
• Cerebral Revascularization
• Child
• Child, Preschool
• Dexmedetomidine (therapeutic use)
• Disease Management
• Disease Progression
• Female
• Fentanyl (therapeutic use)
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Incidence
• Magnetic Resonance Imaging
• Male
• Moyamoya Disease (complications, surgery)
• Neuroimaging
• Postoperative Complications (etiology, prevention & control, therapy)
• Quality of Life
• Risk Factors