{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T07:56:07Z","timestamp":1793519767041,"version":"4.5.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:00:00Z","timestamp":1749427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Childs Nerv Syst"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To discuss the role of surgical revascularization (SR) in inoperable deep-seated brain arteriovenous malformation (bAVM) to treat ischaemic symptoms owing to cerebral hypoperfusion from vascular steal in paediatric patients with vascular steal phenomenon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We discuss the management of two children with high-grade deep-seated bAVMs who underwent indirect SR with encephalo-duro-arterio-myo-synangiosis (EDAMS) and superficial temporal artery (STA) pial synangiosis. Long-term clinical and radiological follow-up were presented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both children aged 11 and 14\u00a0years with deep-seated basal ganglia\/thalamic bAVMs (Spetzler Martin 5, Lawton-Young Supplemented Score 8 who presented with ischaemic-related symptoms (progressive motor deficit). There were no ischaemic lesions evidenced on the MRI. EDAMS with STA pial synangiosis was performed with marked improvement of the progressive and fluctuating symptoms. At 2-year follow-up, angiogram showed satisfactory revascularization from the STA graft to the hypoxemic peri-Rolandic territories. Both patients presented stabilization of clinical symptoms up to 4-year follow-up after IR. There was no evidence of haemorrhage, ischaemia or bAVM progression on follow-up imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SR using indirect techniques may have a role in the management of inoperable deep-seated bAVMs with symptoms due to vascular steal phenomena. The successful revascularization of these cases may also provide evidence to support the hypothesis of vascular steal phenomenon in rapid shunting bAVM causing a local perinidal hypoxemia and neural damage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-025-06844-y","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T17:27:24Z","timestamp":1749490044000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Indirect surgical revascularization for management of vascular steal phenomenon in high-grade untreatable brain arteriovenous malformations"],"prefix":"10.1007","volume":"41","author":[{"given":"Vitor Nagai","family":"Yamaki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Bhate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijeya","family":"Ganesan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fergus","family":"Robertson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Rennie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg","family":"James","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adikarige Haritha Dulanka","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,9]]},"reference":[{"key":"6844_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.3171\/2010.10.PEDS10388","volume":"7","author":"MJ Ellis","year":"2011","unstructured":"Ellis MJ, Armstrong D, Dirks PB (2011) Large vascular malformation in a child presenting with vascular steal phenomenon managed with pial synangiosis. J Neurosurg Pediatr 7:15\u201321. https:\/\/doi.org\/10.3171\/2010.10.PEDS10388","journal-title":"J Neurosurg Pediatr"},{"key":"6844_CR2","doi-asserted-by":"publisher","unstructured":"Moftakhar P, Hauptman JS, Malkasian D, Martin NA (2009) Cerebral arteriovenous malformations. Part 2: physiology. Neurosurg Focus 26. https:\/\/doi.org\/10.3171\/2009.2.FOCUS09317","DOI":"10.3171\/2009.2.FOCUS09317"},{"key":"6844_CR3","doi-asserted-by":"publisher","unstructured":"Meyer B, Schaller C, Frenkel C, Schramm J (1998) Physiological steal around AVMs of the brain is not equivalent to cortical ischemia. Neurol Res 20 Suppl 1: https:\/\/doi.org\/10.1080\/01616412.1998.11740602","DOI":"10.1080\/01616412.1998.11740602"},{"key":"6844_CR4","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1097\/00006123-199606000-00005","volume":"38","author":"LY William","year":"1996","unstructured":"William LY, Abraham K, Eugene O et al (1996) Cerebral hyperemia after arteriovenous malformation resection is related to \u201cbreakthrough\u201d complications but not to feeding artery pressure. The Columbia University Arteriovenous Malformation Study Project. Neurosurgery 38:1085\u20131095. https:\/\/doi.org\/10.1097\/00006123-199606000-00005","journal-title":"Neurosurgery"},{"key":"6844_CR5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1055\/S-2005-868160","volume":"15","author":"ER Smith","year":"2005","unstructured":"Smith ER, Scott RM (2005) Surgical management of moyamoya syndrome. Skull Base 15:15. https:\/\/doi.org\/10.1055\/S-2005-868160","journal-title":"Skull Base"},{"key":"6844_CR6","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1161\/STROKEAHA.107.493080","volume":"39","author":"PL Lasjaunias","year":"2008","unstructured":"Lasjaunias PL, Landrieu P, Rodesch G et al (2008) Cerebral proliferative angiopathy: clinical and angiographic description of an entity different from cerebral AVMs. Stroke 39:878\u2013885. https:\/\/doi.org\/10.1161\/STROKEAHA.107.493080","journal-title":"Stroke"},{"key":"6844_CR7","doi-asserted-by":"publisher","first-page":"89","DOI":"10.3171\/2022.3.PEDS21590","volume":"30","author":"AHD Silva","year":"2022","unstructured":"Silva AHD, Bhate S, Ganesan V et al (2022) Surgical revascularization for pediatric moyamoya: the role of surgical mentorship in sustaining and developing a neurovascular service. J Neurosurg Pediatr 30:89\u201398. https:\/\/doi.org\/10.3171\/2022.3.PEDS21590","journal-title":"J Neurosurg Pediatr"},{"key":"6844_CR8","doi-asserted-by":"publisher","first-page":"E763","DOI":"10.1212\/WNL.0000000000005026","volume":"90","author":"SC Tho-Calvi","year":"2018","unstructured":"Tho-Calvi SC, Thompson D, Saunders D et al (2018) Clinical features, course, and outcomes of a UK cohort of pediatric moyamoya. Neurology 90:E763\u2013E770. https:\/\/doi.org\/10.1212\/WNL.0000000000005026","journal-title":"Neurology"},{"key":"6844_CR9","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1007\/S00381-023-05868-6","volume":"39","author":"KS Lee","year":"2023","unstructured":"Lee KS, Zhang JJY, Bhate S et al (2023) Surgical revascularizations for pediatric moyamoya: a systematic review, meta-analysis, and meta-regression analysis. Childs Nerv Syst 39:1225\u20131243. https:\/\/doi.org\/10.1007\/S00381-023-05868-6","journal-title":"Childs Nerv Syst"},{"key":"6844_CR10","doi-asserted-by":"publisher","first-page":"458","DOI":"10.3171\/2021.11.PEDS21384","volume":"29","author":"AS Montaser","year":"2021","unstructured":"Montaser AS, Srinivasan HL, Staffa SJ et al (2021) Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya. J Neurosurg Pediatr 29:458\u2013466. https:\/\/doi.org\/10.3171\/2021.11.PEDS21384","journal-title":"J Neurosurg Pediatr"},{"key":"6844_CR11","doi-asserted-by":"publisher","first-page":"e200","DOI":"10.1016\/j.jstrokecerebrovasdis.2016.07.042","volume":"25","author":"H Sakata","year":"2016","unstructured":"Sakata H, Fujimura M, Sato K et al (2016) Development of abnormal hemispheric vascular networks mimicking cerebral proliferative angiopathy in a child originally diagnosed with deep-seated arteriovenous fistula. J Stroke Cerebrovasc Dis 25:e200\u2013e204. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2016.07.042","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"6844_CR12","doi-asserted-by":"publisher","unstructured":"Li J (2016) Encephaloduromyosynangiosis (EDMS) on a pediatric patient with cerebral proliferative angiopathy. J Neurol Neurophysiol 07: https:\/\/doi.org\/10.4172\/2155-9562.1000394","DOI":"10.4172\/2155-9562.1000394"},{"key":"6844_CR13","doi-asserted-by":"publisher","first-page":"e360","DOI":"10.1016\/J.WNEU.2022.08.009","volume":"167","author":"YN Chen","year":"2022","unstructured":"Chen YN, Lee CW, Xiao F et al (2022) A proposed algorithm for managing cerebral proliferative angiopathy. World Neurosurg 167:e360\u2013e369. https:\/\/doi.org\/10.1016\/J.WNEU.2022.08.009","journal-title":"World Neurosurg"},{"key":"6844_CR14","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.3171\/2014.7.JNS132793","volume":"121","author":"K Kono","year":"2014","unstructured":"Kono K, Terada T (2014) Encephaloduroarteriosynangiosis for cerebral proliferative angiopathy with cerebral ischemia. J Neurosurg 121:1411\u20131415. https:\/\/doi.org\/10.3171\/2014.7.JNS132793","journal-title":"J Neurosurg"},{"key":"6844_CR15","doi-asserted-by":"publisher","unstructured":"Somji M, McEachern J, Silvaggio J (2019) Cerebral revascularization in cerebral proliferative angiopathy: a systematic review. Neurosurg Focus 46. https:\/\/doi.org\/10.3171\/2018.11.FOCUS18529","DOI":"10.3171\/2018.11.FOCUS18529"},{"key":"6844_CR16","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1097\/00006123-200204000-00002","volume":"50","author":"CL Taylor","year":"2002","unstructured":"Taylor CL, Selman WR, Ratcheson RA et al (2002) Steal affecting the central nervous system. Neurosurgery 50:679\u2013689. https:\/\/doi.org\/10.1097\/00006123-200204000-00002","journal-title":"Neurosurgery"},{"key":"6844_CR17","doi-asserted-by":"publisher","unstructured":"Zhang C, Chau N, Ho H (2020) Patient-specific blood flow analysis for cerebral arteriovenous malformation based on digital subtraction angiography images. Front Bioeng Biotechnol 8:. https:\/\/doi.org\/10.3389\/FBIOE.2020.00775","DOI":"10.3389\/FBIOE.2020.00775"},{"key":"6844_CR18","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1016\/J.WNEU.2019.02.167","volume":"126","author":"M Anglani","year":"2019","unstructured":"Anglani M, Cecchin D, Cester G et al (2019) 18F-Fluorodeoxyglucose positron emission tomography-magnetic resonance monitoring of brain metabolic changes in a case of arteriovenous malformation-related steal phenomenon symptoms. World Neurosurg 126:276\u2013279. https:\/\/doi.org\/10.1016\/J.WNEU.2019.02.167","journal-title":"World Neurosurg"},{"key":"6844_CR19","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1007\/S00381-012-1743-7","volume":"28","author":"J Ng","year":"2012","unstructured":"Ng J, Thompson D, Lumley JPS et al (2012) Surgical revascularisation for childhood moyamoya. Childs Nerv Syst 28:1041\u20131048. https:\/\/doi.org\/10.1007\/S00381-012-1743-7","journal-title":"Childs Nerv Syst"},{"key":"6844_CR20","doi-asserted-by":"publisher","first-page":"142","DOI":"10.3171\/PED.2004.100.2.0142","volume":"100","author":"RM Scott","year":"2004","unstructured":"Scott RM, Smith JL, Robertson RL et al (2004) Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg 100:142\u2013149. https:\/\/doi.org\/10.3171\/PED.2004.100.2.0142","journal-title":"J Neurosurg"},{"key":"6844_CR21","doi-asserted-by":"publisher","first-page":"353","DOI":"10.3171\/2011.12.PEDS1172","volume":"9","author":"ER Smith","year":"2012","unstructured":"Smith ER, Scott RM (2012) Spontaneous occlusion of the circle of Willis in children: pediatric moyamoya summary with proposed evidence-based practice guidelines. A review J Neurosurg Pediatr 9:353\u2013360. https:\/\/doi.org\/10.3171\/2011.12.PEDS1172","journal-title":"A review J Neurosurg Pediatr"},{"key":"6844_CR22","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1177\/23969873221144089","volume":"8","author":"A Bersano","year":"2023","unstructured":"Bersano A, Khan N, Fuentes B et al (2023) European Stroke Organisation (ESO) Guidelines on moyamoya angiopathy endorsed by Vascular European Reference Network (VASCERN). Eur Stroke J 8:55\u201384. https:\/\/doi.org\/10.1177\/23969873221144089","journal-title":"Eur Stroke J"},{"key":"6844_CR23","doi-asserted-by":"crossref","unstructured":"Chin L, Raffel C, \u2026 IG-G-, 1992 undefined Diffuse arteriovenous malformations: a clinical, radiological, and pathological description. journals.lww.com","DOI":"10.1227\/00006123-199211000-00006"},{"key":"6844_CR24","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1007\/S00701-020-04289-7","volume":"162","author":"VN Yamaki","year":"2020","unstructured":"Yamaki VN, Solla DJF, Telles JPM et al (2020) The current clinical picture of cerebral proliferative angiopathy: systematic review. Acta Neurochir (Wien) 162:1727\u20131733. https:\/\/doi.org\/10.1007\/S00701-020-04289-7","journal-title":"Acta Neurochir (Wien)"},{"key":"6844_CR25","doi-asserted-by":"crossref","unstructured":"Lauzier D, Chiang S, Neurology CM-P, (2023) undefined Etiologies of brain arteriovenous malformation recurrence: a focus on pediatric disease. Elsevier","DOI":"10.1016\/j.pediatrneurol.2023.08.022"},{"key":"6844_CR26","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1161\/CIRCRESAHA.111.246116","volume":"110","author":"J L\u00e4hteenvuo","year":"2012","unstructured":"L\u00e4hteenvuo J, Rosenzweig A (2012) Effects of aging on angiogenesis. Circ Res 110:1252\u20131263. https:\/\/doi.org\/10.1161\/CIRCRESAHA.111.246116","journal-title":"Circ Res"},{"key":"6844_CR27","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1007\/S12079-016-0352-8\/METRICS","volume":"10","author":"CS Abhinand","year":"2016","unstructured":"Abhinand CS, Raju R, Soumya SJ et al (2016) VEGF-A\/VEGFR2 signaling network in endothelial cells relevant to angiogenesis. J Cell Commun Signal 10:347\u2013354. https:\/\/doi.org\/10.1007\/S12079-016-0352-8\/METRICS","journal-title":"J Cell Commun Signal"},{"key":"6844_CR28","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1093\/jrr\/rru017","volume":"55","author":"E Yoritsune","year":"2014","unstructured":"Yoritsune E, Furuse M, Kuwabara H et al (2014) Inflammation as well as angiogenesis may participate in the pathophysiology of brain radiation necrosis. J Radiat Res 55:803\u2013811. https:\/\/doi.org\/10.1093\/jrr\/rru017","journal-title":"J Radiat Res"},{"key":"6844_CR29","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1111\/neup.12111","volume":"34","author":"CA Clara","year":"2014","unstructured":"Clara CA, Marie SKN, de Almeida JRW et al (2014) Angiogenesis and expression of PDGF-C, VEGF, CD105 and HIF-1\u03b1 in human glioblastoma. Neuropathology 34:343\u2013352. https:\/\/doi.org\/10.1111\/neup.12111","journal-title":"Neuropathology"},{"key":"6844_CR30","doi-asserted-by":"publisher","first-page":"853","DOI":"10.1016\/J.JSTROKECEREBROVASDIS.2018.11.021","volume":"28","author":"T Kimiwada","year":"2019","unstructured":"Kimiwada T, Hayashi T, Takahashi M et al (2019) Progressive cerebral ischemia and intracerebral hemorrhage after indirect revascularization for a patient with cerebral proliferative angiopathy. J Stroke Cerebrovasc Dis 28:853\u2013858. https:\/\/doi.org\/10.1016\/J.JSTROKECEREBROVASDIS.2018.11.021","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"6844_CR31","doi-asserted-by":"publisher","unstructured":"Ohadi MAD, Iranmehr A, Chavoshi M, et al (2023) Stereotactic radiosurgery outcome for deep-seated cerebral arteriovenous malformations in the brainstem and thalamus\/basal ganglia: systematic review and meta-analysis. Neurosurg Rev 46. https:\/\/doi.org\/10.1007\/S10143-023-02059-4","DOI":"10.1007\/S10143-023-02059-4"}],"container-title":["Child's Nervous System"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-025-06844-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00381-025-06844-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00381-025-06844-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:16:15Z","timestamp":1770815775000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00381-025-06844-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,9]]},"references-count":31,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["6844"],"URL":"https:\/\/doi.org\/10.1007\/s00381-025-06844-y","relation":{},"ISSN":["0256-7040","1433-0350"],"issn-type":[{"value":"0256-7040","type":"print"},{"value":"1433-0350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,9]]},"assertion":[{"value":"13 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"206"}}