{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T00:05:14Z","timestamp":1793232314091,"version":"4.5.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Some pediatric patients with moyamoya disease (MMD) present with posterior cerebral artery (PCA) stenosis before and after anterior circulation revascularization surgery and require posterior circulation revascularization surgery. This study evaluated the factors associated with PCA stenosis and assessed the efficacy of posterior circulation revascularization surgery, including occipital artery (OA)\u2013PCA bypass, in pediatric patients with MMD.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The presence of PCA stenosis before and after anterior circulation revascularization surgery and its clinical characteristics were investigated in 62 pediatric patients (&lt; 16 years of age) with MMD.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Twenty-three pediatric patients (37%) with MMD presented with PCA stenosis at the time of the initial diagnosis. A strong correlation between the presence of infarction and PCA stenosis before anterior revascularization was observed (p &lt; 0.001). In addition, progressive PCA stenosis was observed in 12 patients (19.4%) after anterior revascularization. The presence of infarction and a younger age at the time of initial diagnosis were risk factors for progressive PCA stenosis after anterior revascularization (p &lt; 0.001 and p = 0.002, respectively). Posterior circulation revascularization surgery, including OA-PCA bypass, was performed in 9 of the 12 patients with progressive PCA stenosis, all of whom showed symptomatic and\/or radiological improvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>PCA stenosis is an important clinical factor related to poor prognosis in pediatric MMD. One should be aware of the possibility of progressive PCA stenosis during the postoperative follow-up period and consider performing posterior circulation revascularization surgery.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2018.1.peds17367","type":"journal-article","created":{"date-parts":[[2018,4,6]],"date-time":"2018-04-06T13:55:42Z","timestamp":1523022942000},"page":"632-638","source":"Crossref","is-referenced-by-count":35,"title":["Posterior cerebral artery stenosis and posterior circulation revascularization surgery in pediatric patients with moyamoya disease"],"prefix":"10.3171","volume":"21","author":[{"given":"Tomomi","family":"Kimiwada","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Miyagi Children\u2019s Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiaki","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Sendai City Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reizo","family":"Shirane","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Miyagi Children\u2019s Hospital;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teiji","family":"Tominaga","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"626","DOI":"10.3171\/2013.9.PEDS13111","article-title":"Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease","volume":"12","author":"Funaki T","year":"2013","unstructured":"Funaki T, Takahashi JC, Takagi Y, Yoshida K, Araki Y, Kikuchi T, : Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease. J Neurosurg Pediatr 12:626\u2013632, 201310.3171\/2013.9.PEDS1311124138143"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000336311.60660.26","article-title":"[Revascularization for posterior cerebral artery territory in pediatric moyamoya disease], presented at the 76th Annual Meeting of the Japan Neurosurgical Society","author":"Funaki T","year":"2017","unstructured":"Funaki T, Takahashi JC, Takagi Y, Yoshida K, Kikuchi T, Mineharu Y, : [Revascularization for posterior cerebral artery territory in pediatric moyamoya disease], presented at the 76th Annual Meeting of the Japan Neurosurgical Society. Tokyo: Japan Neurosurgical Society, 2017 (Abstract) (Jpn)10.1227\/01.NEU.0000336311.60660.26"},{"key":"b3","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"E195","DOI":"10.1227\/NEU.0b013e3181f36022","article-title":"Additional surgery for postoperative ischemic symptoms in patients with moyamoya disease: the effectiveness of occipital artery-posterior cerebral artery bypass with an indirect procedure: technical case report","volume":"64","author":"Hayashi T","year":"2009","unstructured":"Hayashi T, Shirane R, Tominaga T: Additional surgery for postoperative ischemic symptoms in patients with moyamoya disease: the effectiveness of occipital artery-posterior cerebral artery bypass with an indirect procedure: technical case report. Neurosurgery 64:E195\u2013E196, 200910.1227\/NEU.0b013e3181f36022"},{"key":"b4","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"961","DOI":"10.3171\/2013.6.JNS122099","article-title":"Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease","volume":"119","author":"Hishikawa T","year":"2013","unstructured":"Hishikawa T, Tokunaga K, Sugiu K, Date I: Assessment of the difference in posterior circulation involvement between pediatric and adult patients with moyamoya disease. J Neurosurg 119:961\u2013965, 20132390925010.3171\/2013.6.JNS122099"},{"key":"b5","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1745","DOI":"10.1007\/s00701-014-2136-3","article-title":"Long-term outcomes in adult patients with ischemic-type moyamoya disease involving posterior circulation","volume":"156","author":"Hishikawa T","year":"2014","unstructured":"Hishikawa T, Tokunaga K, Sugiu K, Date I: Long-term outcomes in adult patients with ischemic-type moyamoya disease involving posterior circulation. Acta Neurochir (Wien) 156:1745\u20131751, 201410.1007\/s00701-014-2136-324866473"},{"key":"b6","series-title":"Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1159\/000228254","article-title":"Clinical significance of posterior circulation changes after revascularization in patients with moyamoya disease","volume":"28","author":"Huang AP","year":"2009","unstructured":"Huang AP, Liu HM, Lai DM, Yang CC, Tsai YH, Wang KC, : Clinical significance of posterior circulation changes after revascularization in patients with moyamoya disease. Cerebrovasc Dis 28:247\u2013257, 20091960287610.1159\/000228254"},{"key":"b7","series-title":"Neurosurgery","first-page":"E1865","article-title":"Progressive PCA steno-occlusive changes after revascularization for moyamoya disease: a neglected phenomenon","volume":"67","author":"Huang AP","year":"2010","unstructured":"Huang AP, Tu YK: Progressive PCA steno-occlusive changes after revascularization for moyamoya disease: a neglected phenomenon. Neurosurgery 67:E1865\u2013E1866, 2010 (Letter)"},{"key":"b8","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"679","DOI":"10.3171\/jns.1978.49.5.0679","article-title":"Treatment of moyamoya disease with STA-MCA anastomosis","volume":"49","author":"Karasawa J","year":"1978","unstructured":"Karasawa J, Kikuchi H, Furuse S, Kawamura J, Sakaki T: Treatment of moyamoya disease with STA-MCA anastomosis. J Neurosurg 49:679\u2013688, 197871239010.3171\/jns.1978.49.5.0679"},{"key":"b9","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2176\/nmc.17pt1.29","article-title":"A surgical treatment of \u201cmoyamoya\u201d disease \u201cencephalo-myo synangiosis\u201d","volume":"17","author":"Karasawa J","year":"1977","unstructured":"Karasawa J, Kikuchi H, Furuse S, Sakaki T, Yoshida Y: A surgical treatment of \u201cmoyamoya\u201d disease \u201cencephalo-myo synangiosis\u201d. Neurol Med Chir (Tokyo) 17:29\u201337, 19777402910.2176\/nmc.17pt1.29"},{"key":"b10","series-title":"Oper Neurosurg (Hagerstown)","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1227\/NEU.0b013e3181f36022","article-title":"Direct anastomosis using occipital artery for additional revascularization in moyamoya disease after combined superficial temporal artery-middle cerebral artery and indirect bypass","volume":"13","author":"Kazumata K","year":"2017","unstructured":"Kazumata K, Kamiyama H, Saito H, Maruichi K, Ito M, Uchino H, : Direct anastomosis using occipital artery for additional revascularization in moyamoya disease after combined superficial temporal artery-middle cerebral artery and indirect bypass. Oper Neurosurg (Hagerstown) 13:213\u2013223, 20172892721410.1227\/NEU.0b013e3181f36022"},{"key":"b11","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1227\/01.NEU.0000369606.00861.91","article-title":"Novel bypass surgery for moyamoya disease using pericranial flap: its impacts on cerebral hemodynamics and long-term outcome","volume":"66","author":"Kuroda S","year":"2010","unstructured":"Kuroda S, Houkin K, Ishikawa T, Nakayama N, Iwasaki Y: Novel bypass surgery for moyamoya disease using pericranial flap: its impacts on cerebral hemodynamics and long-term outcome. Neurosurgery 66:1093\u20131101, 20102049542410.1227\/01.NEU.0000369606.00861.91"},{"key":"b12","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"2305","DOI":"10.1007\/s00415-014-7484-7","article-title":"Delayed posterior circulation insufficiency in pediatric moyamoya disease","volume":"261","author":"Lee JY","year":"2014","unstructured":"Lee JY, Choi YH, Cheon JE, Paeng JC, Ryu HW, Kim KJ, : Delayed posterior circulation insufficiency in pediatric moyamoya disease. J Neurol 261:2305\u20132313, 201410.1007\/s00415-014-7484-725212285"},{"key":"b13","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"2263","DOI":"10.1007\/s00381-013-2123-7","article-title":"Posterior cerebral artery involvement in moyamoya disease: initial infarction and angle between PCA and basilar artery","volume":"29","author":"Lee JY","year":"2013","unstructured":"Lee JY, Kim SK, Cheon JE, Choi JW, Phi JH, Kim IO, : Posterior cerebral artery involvement in moyamoya disease: initial infarction and angle between PCA and basilar artery. Childs Nerv Syst 29:2263\u20132269, 20132365314110.1007\/s00381-013-2123-7"},{"key":"b14","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1161\/01.STR.17.1.117","article-title":"The specificity of the collaterals to the brain through the study and surgical treatment of moyamoya disease","volume":"17","author":"Matsushima Y","year":"1986","unstructured":"Matsushima Y, Inaba Y: The specificity of the collaterals to the brain through the study and surgical treatment of moyamoya disease. Stroke 17:117\u2013122, 198610.1161\/01.STR.17.1.117"},{"key":"b15","series-title":"No Shinkei Geka","first-page":"1559","article-title":"[Effects of indirect EC\/IC bypass operations on adult moyamoya patients.]","volume":"14","author":"Matsushima Y","year":"1986","unstructured":"Matsushima Y, Suzuki R, Yamaguchi T, Tabata H, Inaba Y: [Effects of indirect EC\/IC bypass operations on adult moyamoya patients.] No Shinkei Geka 14:1559\u20131566, 1986 (Jpn)3822055"},{"key":"b16","series-title":"No To Hattatsu","first-page":"3","article-title":"[Changes in symptoms after encephalo-duro-arterio-synangiosis (EDAS) in pediatric moyamoya disease.]","volume":"18","author":"Matsushima Y","year":"1986","unstructured":"Matsushima Y, Yamaguchi T, Takasato Y, Tomida S, Fukumoto T, Suzuki R, : [Changes in symptoms after encephalo-duro-arterio-synangiosis (EDAS) in pediatric moyamoya disease.] No To Hattatsu 18:3\u20137, 1986 (Jpn)3718770"},{"key":"b17","series-title":"No To Shinkei","first-page":"765","article-title":"[Visual disturbances in moyamoya disease.]","volume":"38","author":"Miyamoto S","year":"1986","unstructured":"Miyamoto S, Kikuchi H, Karasawa J, Nagata I: [Visual disturbances in moyamoya disease.] No To Shinkei 38:765\u2013772, 1986 (Jpn)3768188"},{"key":"b18","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"454","DOI":"10.3171\/jns.1986.65.4.0454","article-title":"Study of the posterior circulation in moyamoya disease. Part 2: Visual disturbances and surgical treatment","volume":"65","author":"Miyamoto S","year":"1986","unstructured":"Miyamoto S, Kikuchi H, Karasawa J, Nagata I, Ihara I, Yamagata S: Study of the posterior circulation in moyamoya disease. Part 2: Visual disturbances and surgical treatment. J Neurosurg 65:454\u2013460, 198610.3171\/jns.1986.65.4.04543760953"},{"key":"b19","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/0090-3019(84)90222-2","article-title":"Moyamoya disease associated with bilateral occlusion of the vertebral artery","volume":"22","author":"Miyamoto S","year":"1984","unstructured":"Miyamoto S, Kikuchi H, Karasawa J, Nagata I, Ikota T: Moyamoya disease associated with bilateral occlusion of the vertebral artery. Surg Neurol 22:21\u201328, 1984672968510.1016\/0090-3019(84)90222-2"},{"key":"b20","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.3171\/jns.1984.61.6.1032","article-title":"Study of the posterior circulation in moyamoya disease. Clinical and neuroradiological evaluation","volume":"61","author":"Miyamoto S","year":"1984","unstructured":"Miyamoto S, Kikuchi H, Karasawa J, Nagata I, Ikota T, Takeuchi S: Study of the posterior circulation in moyamoya disease. Clinical and neuroradiological evaluation. J Neurosurg 61:1032\u20131037, 1984650223110.3171\/jns.1984.61.6.1032"},{"key":"b21","series-title":"No To Shinkei","first-page":"491","article-title":"[Study on the vertebro-basilar system in \u201cmoyamoya\u201d disease.]","volume":"36","author":"Miyamoto S","year":"1984","unstructured":"Miyamoto S, Kikuchi H, Karasawa J, Nagata I, Ikota T, Takeuchi S: [Study on the vertebro-basilar system in \u201cmoyamoya\u201d disease.] No To Shinkei 36:491\u2013499, 1984 (Jpn)"},{"key":"b22","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1212\/WNL.0b013e318249f71f","article-title":"Homozygous c.14576G>A variant of RNF213 predicts early-onset and severe form of moyamoya disease","volume":"78","author":"Miyatake S","year":"2012","unstructured":"Miyatake S, Miyake N, Touho H, Nishimura-Tadaki A, Kondo Y, Okada I, : Homozygous c.14576G>A variant of RNF213 predicts early-onset and severe form of moyamoya disease. Neurology 78:803\u2013810, 20122237781310.1212\/WNL.0b013e318249f71f"},{"key":"b23","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"192","DOI":"10.3174\/ajnr.A2216","article-title":"Posterior circulation and high prevalence of ischemic stroke among young pediatric patients with moyamoya disease: evidence of angiography-based differences by age at diagnosis","volume":"32","author":"Mugikura S","year":"2011","unstructured":"Mugikura S, Higano S, Shirane R, Fujimura M, Shimanuki Y, Takahashi S: Posterior circulation and high prevalence of ischemic stroke among young pediatric patients with moyamoya disease: evidence of angiography-based differences by age at diagnosis. AJNR Am J Neuroradiol 32:192\u2013198, 20112080176110.3174\/ajnr.A2216"},{"key":"b24","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.3171\/2013.11.JNS132502","article-title":"Posterior circulation in moyamoya","volume":"120","author":"Mugikura S","year":"2014","unstructured":"Mugikura S, Takahashi S: Posterior circulation in moyamoya. J Neurosurg 120:1240\u20131241, 201410.3171\/2013.11.JNS13250224527819"},{"key":"b25","series-title":"Neurol Med Chir (Tokyo)","first-page":"245","article-title":"Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis)","volume":"52","year":"2012","unstructured":"Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis: Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo) 52:245\u2013266, 201222870528"},{"key":"b26","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/archneur.1969.00480090076012","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki J","year":"1969","unstructured":"Suzuki J, Takaku A: Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol 20:288\u2013299, 1969577528310.1001\/archneur.1969.00480090076012"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/6\/article-p632.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/6\/article-p632.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/6\/article-p632.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:48:33Z","timestamp":1681566513000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/6\/article-p632.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6]]},"references-count":26,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2018.1.peds17367","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6]]}}}