{"id":"decdd911-ee6d-4a42-9ca9-14b4093bc0d5","slug":"indirect-revascularization-for-moyamoya-disease-a-pediatric-neuroanesthesiology-perspective","title":"Indirect revascularization for moyamoya disease: A pediatric neuroanesthesiology perspective","authors":["Karla E. K. Wyatt","Sandi K. Lam","Nisha Gadgil"],"abstract":"Background: Moyamoya disease is a progressive cerebrovascular disorder characterized by narrowing and occlusion of major cerebral arteries, leading to the formation of collateral vessels. It is rare in the pediatric population, typically presenting with ischemic strokes or transient ischemic attacks. The pathogenesis remains unclear, with genetic and inflammatory factors suggested as potential contributors. Methods: A 4-year-old male patient with moyamoya disease underwent indirect revascularization surgery, specifically encephaloduroarteriosynangiosis and dural inversion. Anesthesia was managed with intravenous dexmedetomidine for anxiolysis, followed by standard induction agents and maintenance with sevoflurane and dexmedetomidine infusion. Vital signs were closely monitored, and hemodynamic stability was maintained throughout the procedure. Results: The patient experienced a brief episode of hypotension during surgery, which was successfully managed. Post-operative cerebral angiogram at six months demonstrated extensive new collateral circulation, classified as Matsushima grade A, with the patient showing no recurrent ischemic events and resolution of right-sided hemiparesis at the last follow-up six years post-operatively. Conclusion: Indirect revascularization for moyamoya disease in pediatric patients can be performed safely with careful anesthetic management. The procedure resulted in significant improvement in collateral circulation and clinical outcomes, highlighting its efficacy in treating this rare condition. Keywords: moyamoya disease, pediatric, neuroanesthesiology, revascularization, ischemic stroke, anesthesia management","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/decdd911-ee6d-4a42-9ca9-14b4093bc0d5/featured/hero-1782424746062.png","publishDate":"2018-11-02T00:00:00.000Z","doi":"10.4103/sni.sni_151_18","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/decdd911-ee6d-4a42-9ca9-14b4093bc0d5/pdf"}