Anesthetic Management of Encephaloduroarteriosynangiosis (EDAS) for Moyamoya Disease: A Retrospective Study

Background: Moyamoya Disease (MMD) is a chronic cerebrovascular disease with progressive stenosis/occlusion of terminal portions of ICA and development of cerebral ischemia. Encephaloduroarteriosynangiosis (EDAS) is performed to improve the collaterals. There are many risk factors for development of perioperative stroke which were reviewed in this study.

Methods and Materials: This retrospective study included children who underwent EDAS over 7-year period (May 2012–May 2019). All the necessary data were collected from computerized case records, inpatient hospital records and anesthesia records.

Results: A total of 45 children who underwent 52 procedures of EDAS for Moyamoya disease were identified with a median age of 8 years (IQR: 4.5–11.5), male preponderance (M:F = 25:20), median body weight of 30 kg (IQR: 18.25–42), and mean BMI of 19.2 ± 5.6 kg/m2. All children (100%) had previous stroke at presentation with 2 years (IQR: 1–4) median duration of symptoms at presentation. They received GA with controlled ventilation using air, oxygen, sevoflurane, or isoflurane and regional scalp block using 0.2% bupivacaine/0.2% ropivacaine for analgesia at the beginning and end of surgery. Hemodynamics were maintained within the baseline. Eight (15.4%) children developed neurological deficits following surgery, among which five had permanent deficits and three had transient deficits which improved with hemodynamic management and hydration. The baseline parameters, possible risk factors, and outcome variables between the patients who developed postoperative deficits and those who did not develop postoperative deficits were compared.

Conclusions: Preoperative hydration and postoperative analgesia with intravenous fentanyl and scalp block reduced the incidence of postoperative stroke.

Publication History

Article published online:
25 March 2020