Neurologlcal Improvement after Vascular Reconstruction of a Failed EDAS in Childhood Moyamoya Disease Complicated by a Major Stroke : A Case Report

The authors discuss the case of a 9-year-old boy who was admitted to hospital on February 29, 1992 because of persistent right hemiparesis, motor aphasia, and mental retardation. On August 11, 1991, he had sustained a cerebral infarction with right hemiplegia and total aphasia and had been diagnosed as having moyamoya disease. Thus, on October 11, 1991, he underwent a left encephalo-duro-arterio-synangiosis (EDAS), but his neurological deficits did not significantly improve. Because of this failed EDAS, a vascular reconstruction was performed at our institution, and the superficial temporal artery that was used for the EDAS was stripped from the cortical surface and anastomosed to the central artery, which had a diameter of about 0.2 mm. Postoperatively, marked improvement was noted in his hemiparesis, motor aphasia, and mental retardation. In summary, based on the results in this case, surgical revascularization is thought to be needed even in childhood moyamoya disease cases that are complicated by a major stroke.