Pediatric neurology briefs

Neurosurgeons at the Hospital for Sick Children and Western Hospitals, Toronto, Canada, review their experiences during a 6 month co 15 year follow up of 25 children with moyamoya disease 15 or whom underwent revascularization procedures. Five patients had superficial temporal artery-middle cerebral artery (STA-MCA) bypass procedures and 13 underwent encephalo-duro-arterio-synangiosis (EDAS), a procedure expected to induce collateral branches to sprout from the STA. Of the untreated cases, 75% developed permanent neurological sequelae, including seizures, hemiparesis and mental retardation, and 2 died. Among the 13 treated cases, 10 were neurologically intact and the remainder were improved. The STA-MCA was the procedure of choice in older children whereas EDAS, including opening of the arachnoid, a simpler technique, gave good results and was preferred in infants and young children. The authors suggest that all pediatric patients be offered the benefit of early surgical treatment before permanent neurological deficits have developed. (Olds MV, Griebel RW, Hoffman HJ et al. J Neurosurg 1987; 66:675-680).