Practice variability in the perioperative management of pediatric moyamoya disease in North America

J Stroke Cerebrovasc Dis. 2023 Apr;32(4):107029. doi: 10.1016/j.jstrokecerebrovasdis.2023.107029. Epub 2023 Jan 25.

Abstract

Background: Revascularization surgery decreases the long-term risk of stroke in children with moyamoya but carries an increased risk of perioperative ischemic events. Evidence-based approaches to safe perioperative management of children with moyamoya are limited. We aimed to understand practice variability in perioperative moyamoya care.

Methods: Neurologists, neurosurgeons, and intensivists practicing in North America with expertise in perioperative pediatric moyamoya care participated in a 138-item anonymous survey focused on interdisciplinary perioperative care surrounding indirect revascularization surgery.

Results: Many perioperative care practices vary substantially between participants. Timing of resumption of antiplatelet therapy postoperatively, choice of sedative agents and vasopressors, goal blood pressures, rate and duration of intravenous fluid administration, and red blood cell transfusion thresholds are among the most variable practices.

Conclusions: This practice variability survey highlights several important knowledge gaps and areas of equipoise that should be targets for future investigation and consensus-building efforts.

Keywords: Childhood stroke; Moyamoya; Pediatric stroke; Revascularization.

MeSH terms

  • Cerebral Revascularization* / adverse effects
  • Child
  • Humans
  • Hypnotics and Sedatives
  • Moyamoya Disease* / diagnostic imaging
  • Moyamoya Disease* / etiology
  • Moyamoya Disease* / surgery
  • Perioperative Care / adverse effects
  • Stroke* / etiology
  • Treatment Outcome

Substances

  • Hypnotics and Sedatives

Supplementary concepts

  • Moyamoya disease 1