SESSION 11: New technologies in Pediatric Neurosurgery
Management strategy in pediatric moyamoya angiopathy: the Zurich
Moyamoya Center experience
Nadia Khan1, Dubravka Deanovic2, Martin Hoelzle2, Martina Hug3, Annette Hackenberg4,
Alfred Buck5, Gerasimos Baltsavias6
1 Moyamoya Center, University Children’s Hospital Zurich, Switzerland
2 Department of Anesthesiology, University Children’s Hospital Zurich, Switzerland
3 Center for Child Development, University Children’s Hospital Zurich, Switzerland
4 Department of Pediatric Neurology, University Children’s Hospital Zurich, Switzerland
5 Department of Nuclear Medicine, University Hospital Zurich, Switzerland
6 Department of Neuroradiology, University Hospital Zurich, Switzerland
Introduction and Objectives:
Moyamoya is a dynamic and progressive steno-occlusive angiopathy
of the circle of Willis presenting with repetitive ischemic strokes In the pediatric age group. The
management strategy of newly diagnosed children referred to our moyamoya center is presented.
Method / Patient Selection:
Twenty-six newly diagnosed moyamoya children, referred from within
Europe and internationally, were managed at our moyamoya center between March 2011 - December
2013. Mean age was 8 years (range 1-17 years). Female to male ratio was 15:11.
Diagnostic workup consisted of clinical-neurological evaluation including child
development/cognition testing, diagnostic 6-vessel cerebral angiography, MRI and H215O-PET scan
with Diamox challenge.
Headache and transient ischemic attacks were common presenting symptoms. Moyamoya syndrome
was seen in half of the children (13/26). Two of the syndromic moyamoya children were asymptomatic
clinically. Bilateral cortical/subcortical infarcts in distribution territories of anterior cerebral artery (ACA),
middle cerebral artery (MCA) and/or posterior cerebral artery (PCA) were seen mainly in children of
age < 5 years. Unilateral angiopathy was seen in 4 children. Twenty-four children showed bilaterally
decreased perfusion reserves on Diamox-H215O-PET in ACA, MCA and /or PCA territories.
Depending on symptomatology, extent of angiopathy and territorial perfusion reserve deficits, multiple
1 or 2 staged cerebral revascularization surgeries were performed. Clinical-neuroradiological follow up
at 6 months and 1-3 years after last surgery is ongoing and to be continued into adulthood.The first 15
children at average post-op follow up of 9 months (6 months-1 year) remain stroke free.
Moyamoya in Europe and internationally is highlighted. It is not only limited to the Asian
population. Accurate diagnostic work-up and thorough pre surgical planning is necessary for a good
clinical outcome. A dedicated center i.e. an interdisciplinary medical and neurosurgical team with an
infrastructure appropriate for the pediatric age group is pivotal for optimal management.
24th ESPN Congress (Rome-Italy • May 4-7, 2014)
3. Responses to the Remarks and Proposals of the Department of Environment of the Republic of Latvia Remark 1: The documentation about influence on the environment does not contain a qualitative and quantitative estimation of the possible radiation contamination which may influence on the territory of Latvia in case of the accident. Such estimation is required for assessment of the condi
Government of India Department of Commerce Ministry of Commerce & Industry Directorate General of Anti-Dumping & Allied Duties Udyog Bhawan, New Delhi INITIATION NOTIFICATION Subject: Initiation of Anti-Dumping investigations concerning Imports of Chloroquine Phosphate from China PR. No.14/3/2003-DGAD. .A petition has jointly been filed by M/s. Ipca Laboratories Ltd.,