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Some medical treatments, such as aspirin and other anti-clotting medications can reduce the risk of a damaging stroke, but the disease continues to progress. Several surgical solutions have been very effective at bypassing the narrowed artery and creating a new blood supply for the affected areas of the brain.
At Children's Hospital Boston, neurosurgeons prefer pial synangiosis, in which a healthy blood vessel from the scalp is moved so it runs under a section of the skull and is stitched to the surface of the brain. Pial synangiosis does not require severing and reconnecting the tiny scalp and brain arteries -- a significant advantage, especially in young children.
Like a new plant setting out roots in fertile soil, the transplanted artery grows a network of healthy new arteries to serve the oxygen-deprived areas of the brain. Research carried out in Children's Hospital laboratories has shown that growth factors circulating in cerebrospinal fluid especially encourage the development of these new blood vessels.
Although it takes three to six months to realize the full benefits of the surgery, the procedure is very effective, and because of the very small blood vessels that most children with moyamoya have, is a better alternative than a direct bypass operation for most pediatric patients. On long-term follow-up of 143 moyamoya cases treated with pial synangiosis in the past 17 years at Children's, the published stroke incidence diminished from more than 67 percent to less than 7 percent.
Following surgery, most patients will stay in the hospital for about a week, then return in about 6 weeks so their surgeon can check on their progress. At six months to one year following surgery, an angiogram is usually done to confirm that new blood vessels are growing where they are needed. Annual MRI follow up is usually sufficient after that point.
For patients who have long-term damage from strokes, treatment will also focus on physical therapy, speech therapy and occupational therapy to help them regain function and cope with any remaining disability.
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