17 4 K Ngoai TK Multiple bur hole surgery for the treatment of Moyamoya Disease

17 4 K Ngoai TK Multiple bur hole surgery for the treatment of Moyamoya Disease tài liệu, giáo án, bài giảng , luận văn,...

Pediatric Neurosurgery Department

Children Hospital No.2

MULTIPLE BUR HOLES SURGERY

FOR THE TREATMENT OF

MOYAMOYA DISEASE

CHILDREN

Pediatric Neurosurgery

Department-INTRODUCTION

• 1957, Takeuchi & Shimizu -Japan

• 1957, Takeuchi & Shimizu -Japan

• “something hazy, like a puff of cigarette smoke”

Japan hazy, like a puff of

EPIDEMIOLOGY

ASSOCIATED CONDITIONS

of the vessel wall components and

abundant intraluminal thrombi

CLINICAL FEATURES

• In children, symptomatic episodes of ischemia may be triggered

by exercise, crying, coughing, straining, fever, or hyperventilation

In children, symptomatic episodes of ischemia may be triggered

by exercise, crying, coughing, straining, fever, or hyperventilation

IMAGING

NATURAL HISTORY AND PROGNOSIS

• Tends to be progressive, bilateral:

• Tends to be progressive, bilateral:

Progressive neurologic deficits and poor Two thirds of patients with moyamoyaprogression over a 5-year period

More rapid progression and a worse prognosis in younger than in older children

Prognosis: Poor without treatment

NATURAL HISTORY AND PROGNOSIS

neurologic deficits and poor outcome: 50 to 66 percent

moyamoya have symptomatic

rapid progression and a worse prognosis in younger than in

Prognosis: Poor without treatment

SUZUKI STAGE

Medical treatment

Treatment Surgery

Endovascular Therapy

STA-MCA bypass

Indirect

Encephalo… synangiosis

Direct

Multiple burr

holes

MUTIPLE BURR HOLES SURGERY

• 1984, Masataka Endo –

• Neovascularization occurring across a

frontal burr hole / external drainage of

intraventricle hemorrhage.

BURR HOLES SURGERY

CASE REPORT

CASE REPORTS

Multiple Bur Hole Surgery For The Treatment

Of Moyamoya Disease In Children

(http://www.ncbi.nlm.nih.gov/pubmed/17184074

CHRISTIAN SAINTE-ROSE, M.D., RICARDO OLIVEIRA, M.D., STÉPHANIE PUGET, M.D.,

THORNE, F.R.C.S., ALISON WRAY, F.R.A.C.S., MICHEL ZERAH, M.D., AND MARIE BOURGEOIS, M.D

•• 14 patients ( mean age 6.5yr )

• Post-op MRI: restoration of cortical

months

• Conclusion: effective and safe

• Conclusion: effective and safe

Furthermore, it is effective supplementary revascularization procedures

Multiple Bur Hole Surgery For The Treatment

Disease In Children.

(http://www.ncbi.nlm.nih.gov/pubmed/17184074)

ROSE, M.D., RICARDO OLIVEIRA, M.D., STÉPHANIE PUGET, M.D., LIANA BENI-ADANI, M.D., NATHALIE BODDAERT, M.D., JOHN

WRAY, F.R.A.C.S., MICHEL ZERAH, M.D., AND MARIE BOURGEOIS, M.D

14 patients ( mean age 6.5yr ) – France & Australia

restoration of cortical perfusion as early as 3

effective and safe effective and safe

, it is effective as a sole treatment without supplementary revascularization procedures

Multiple Burr

As A Treatment Modality For Pediatric

(http://www.ncbi.nlm.nih.gov/pubmed/21559155) RAVINDRANATH KAPU, NIGEL PETER

around the burr hole sites

• Conclusion: effective and safe,

revascularization procedures

Burr Hole Surgery

As A Treatment Modality For Pediatric Moyamoya Disease

(http://www.ncbi.nlm.nih.gov/pubmed/21559155)

, NIGEL PETER SYMSS, [ ], AND RAVI RAMAMURTHI

op, excellent cerebral revascularization

safe, without supplementary

Effect Of Multiple Cranial

Prevention Of Recurrent Ischemic Attacks In Children

With Moyamoya

(http://www.ncbi.nlm.nih.gov/pubmed/20446218

OLIVEIRA RS 1 , AMATO MC , SIMÃO GN , ABUD DG

• Brasil – 7 pts

• No recurrence of ischemic attacks postoperatively

• Neoangiogenesis was observed in both hemispheres

• Neoangiogenesis was observed in both hemispheres

• Conclusion: simple procedure,

complications, effective for preventing cerebral ischemic attacks

Effect Of Multiple Cranial Burr Hole Surgery On

Prevention Of Recurrent Ischemic Attacks In Children

Moyamoya disease.

http://www.ncbi.nlm.nih.gov/pubmed/20446218)

ABUD DG , AVIDAGO EB , SPECIAN CM , MACHADO HR

No recurrence of ischemic attacks postoperatively

was observed in both hemispheres

procedure, relatively low risk of effective for preventing cerebral ischemic

Long Time Follow Up Of Patients With

Disease Treated By Multiple Burr Hole Surgery

(http://stroke.ahajournals.org/cgi/content/meeting_abstract/44/2_meetingabstracts/awp170)

YOSHITO UCHIHASHI 1 ; KOHKICHI HOSODA 1 ; TETSURO

•• Japan- 46 pts ( mean age 40)

• Average Follow up period: 10,8

• Conclusion:

- similar long-term results compared

- similar long-term results compared with direct bypass

- easily done, performed in any place

Long Time Follow Up Of Patients With Moyamoya Disease Treated By Multiple Burr Hole Surgery

(http://stroke.ahajournals.org/cgi/content/meeting_abstract/44/2_meetingabstracts/awp170)

KAWAGUCHI 2 ; MITSUGU NAKAMURA 3 ; EIJI KOHMURA

Average Follow up period: 10,8 yrs

term results compared

done, performed in any place

Hemodynamic Change Of Childhood

Disease After Multiple Burr

(http://manu22.magtech.com.cn/Jweb_zzzz/EN/volumn/current.shtml)

SUN JIAN*, WANG LI-SHU, ZHANG DONG, ET AL

• 8 pts – China (Chinese Journal of Stroke )

• 8 pts – China (Chinese Journal of Stroke )

• Using multicolor ultraphonic power Doppler + SPECT

• 1st week post-op: neovascularization

• 3rd month: rich neovascularization

• Conclusion: The burr-hole operation can improve the ischemia of childhood moyamoya disease

Hemodynamic Change Of Childhood Moyamoya

Disease After Multiple Burr-hole Operation

(http://manu22.magtech.com.cn/Jweb_zzzz/EN/volumn/current.shtml)

SHU, ZHANG DONG, ET AL

China (Chinese Journal of Stroke )

power Doppler + SPECTop: neovascularization

: rich neovascularization

hole operation can improve the ischemia of

Effectiveness Of Burr Holes For Indirect Revascularization

In Patients With Moyamoya

a Review Of The Literature

01/2013 Pubmed and Medline, 1970

versatile tool in the armamentarium of surgeons treating children and adults with MMD, allowing tailoring of the revascularization

Effectiveness Of Burr Holes For Indirect Revascularization

Moyamoya Disease—

a Review Of The Literature

and Medline, 1970- 2012Burr hole surgery is an important and versatile tool in the armamentarium of surgeons treating children and adults with MMD, allowing tailoring of the revascularization

• Moyamoya disease- chronic progressive cerebrovascular

bilateral stenosis or occlusion of the arteries around the circle of Willis

• Patients often suffer cognitive and neurologic decline due to

repeated ischemic stroke or hemorrhage

• Outcome: poor without treatment

• MBHO: effective and safe, and can be used as the only treatment

• MBHO: effective and safe, and can be used as the only treatment without supplementary revascularization

• In children, symptomatic episodes of ischemia may be triggered

by exercise, crying, coughing, straining, fever, or hyperventilation

effective and safe, and can be used as the only treatment without supplementary revascularization procedures

In children, symptomatic episodes of ischemia may be triggered

by exercise, crying, coughing, straining, fever, or hyperventilation

Thank You For Your Attention