Occipital pial synangiosis

摘要

Background: Indirect revascularization techniques for posterior circulation moyamoya are infrequently described in the literature given the relative rarity of the disease process, particularly in the best candidates for indirect approaches-children. Methods: We present a detailed, illustrated video demonstration of the occipital pial synangiosis procedure performed in a 5-year-old child. Conclusion: The specific advantages of the pial synangiosis technique - suturing the donor vessel to the pia and a wide arachnoidal opening - can be successfully applied to posterior circulation indirect revascularization. Key Points: ? Perioperative hydration and aspirin limit the risk of perioperative stroke. ? Pain control and maintained normocapnea limit the risk of perioperative ischemic events. ? The posterior auricular artery may be an alternative donor vessel. ? The donor vessel is dissected from distal to proximal; forceps protect it during skin incision. ? The donor vessel is dissected along a generous length to minimize tension. ? Coagulation of the dura is limited as meningeal vessels may serve as synergistic collaterals. ? A wide arachnoidal opening facilitates the ingrowth of collateral vessels. ? Suturing the donor vessel to the pia ensures it remains well apposed to the brain surface. ? The dura is left open to encourage ingrowth of collateral vessels and limit tension on the donor vessel. ? EEG monitoring is a crucial adjunct.