Neurological Disorders & Stroke

Pediatric Moyamoya is a progressive neurological disorder in which the intracranial carotid arteries become slowly occluded leading to strokes. This can be especially debilitating in children leading to significant motor and cognitive delays in the young brain. There are some distinctive etiologies such as Down’s syndrome and Sickle cell disease which may lead to Moyamoya, especially in the younger population. Apart from medical management, the progressive natural history of this disease requires a multidisciplinary approach early to reduce future stroke morbidity. Early identification of symptoms of stroke in the very young can be difficult, and it is imperative to correctly identify Moyamoya as early as possible. Apart from the initial medical management, there are various surgical options which are all tailored to augment blood flow to the area of hypoperfusion in the brain. The surgical literature yields several options, all based on the severity of disease and is customized to each child. The revascularization options to the brain may be broadly divided into direct and indirect options, based on the age of the child and anatomical cerebral blood flow assessment based on MRI, CT angiography, and/or cerebral angiogram. The surgical technique varies based on surgical experience and long-term studies show good success with revascularization surgery.