INDIRECT REVASCULARIZATION SURGERY IN CHILDREN WITH CISTIC ATROPHIC BRAIN LESIONS
The aim of paper is to examine the results of indirect revascularization operations in treatment of moyamoya disease, consequences of birth traumas and hemorrhages leading to great vessels occlusion and cystic atrophic changes. Indirect revascularization surgery (pial synangiosis, encephaloduroarterio(myo)synangiosis, galeopial synangiosis through burr holes, dural inversion) was applied for treatment of 8 children with moyamoya disease and 10 children with local morphological changes of the brain and arterial occlusive disease that vascularized the affected area. Before and after the operation neurophysiologic research (EEG) and neurovisualization (CT, CT angiography, MRI, MR angiography, triplex ultrasonography, PET, SPECT, etc.) had been done. The viability of anastomosis was achieved in 7 of 8 patients with moyamoya disease and in 6 of 8 patients with cystic glial changes of the brain. Partial or complete regression of clinical implications was achieved in all patients of both groups. Indirect revascularization surgery (IRS) is the treatment of choice for cerebral revascularization in children of younger age groups, as well as in cases of moyamoya disease. In cases of local cysts formation and occlusion of blood vessels which feed this area in children with consequences of perinatal and postnatal lesions and congenital neurologic impairment it is appropriate to include IRS in the combined surgical treatment.