Risk factors for postoperative ischemic complications in patients with moyamoya disease

Object. The aim of this study was to determine the risk factors associated with the development of postoperative ischemic complications after surgical revascularization used to treat pediatric patients with ischemic moyamoya disease. Methods. The clinical, imaging, and perioperative data from 170 procedures in 90 children who underwent indirect revascularization surgery were retrospectively reviewed. To clarify the risk factors, cases with identified ischemic complications and those without such events were compared. For this study, a postoperative ischemic complication was defined as a newly developed infarction within 2 weeks after surgery, which was confirmed by follow-up imaging studies. Conclusions. The higher ischemic risks from surgical treatment should be considered for patients with moyamoya disease who are younger than 3 years of age and have a preoperative cerebral infarction. It is also recommended that the revascularization surgery be delayed for at least 6 weeks after the development of the previous cerebral infarction.