{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:50:37Z","timestamp":1791273037955,"version":"4.1.0"},"reference-count":41,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Numerous surgical procedures facilitate revascularization of the ischemic brain in patients with moyamoya disease. Dural inversion is a technique in which flaps of dura mater centered around the middle meningeal artery are inverted, encouraging the formation of a rich collateral blood supply. This procedure has been used in combination with encephaloduroarteriosynangiosis for more than 20 years at the authors\u2019 institution for the treatment of pediatric moyamoya disease. The objective of this study was to describe the clinical and radiographic outcomes for a cohort of consecutive pediatric moyamoya patients undergoing dural inversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Clinical and radiographic data on patients who had undergone dural inversion in the period from 1997 to 2016 were reviewed. Univariate and multivariate logistic regression and Kaplan-Meier analyses were performed to assess the risk of postoperative stroke, functional outcome, and the angiographic degree of revascularization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Dural inversion was performed on 169 hemispheres in 102 patients. Median follow-up was 4.3 years. Six patients (3.6% of hemispheres) suffered postoperative ischemic or hemorrhagic stroke. Overall mortality was 1.0%. Good postoperative neurological status (modified Rankin Scale [mRS] score \u2264 2) was observed in 90 patients (88%); preoperative and postoperative mRS scores showed significant improvement (p &lt; 0.001). Eighty-six percent of hemispheres had Matsushima grade A or B revascularization. Younger age was associated with postoperative stroke and poor functional outcome. Patients with secondary moyamoya syndrome had a significantly worse radiographic outcome. The cumulative 5-year Kaplan-Meier risk for stroke was 6.4%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Dural inversion is a useful technique of cerebral revascularization in pediatric moyamoya disease. A 20-year experience demonstrates the safety and efficacy of this technique with a relatively low rate of postoperative stroke, good functional outcomes, and favorable angiographic results.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2018.5.peds18163","type":"journal-article","created":{"date-parts":[[2018,8,17]],"date-time":"2018-08-17T09:55:57Z","timestamp":1534499757000},"page":"541-549","source":"Crossref","is-referenced-by-count":35,"title":["Indirect revascularization with the dural inversion technique for pediatric moyamoya disease: 20-year experience"],"prefix":"10.3171","volume":"22","author":[{"given":"Nisha","family":"Gadgil","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine\/Texas Children\u2019s Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandi","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine\/Texas Children\u2019s Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Pyarali","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine\/Texas Children\u2019s Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Paldino","sequence":"additional","affiliation":[{"name":"Department of Radiology, Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Wen","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine\/Texas Children\u2019s Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Dauser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine\/Texas Children\u2019s Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1159\/000120932","article-title":"Pial synangiosis for moyamoya syndrome in children","volume":"23","author":"Adelson PD","year":"1995","unstructured":"Adelson PD, Scott RM: Pial synangiosis for moyamoya syndrome in children. 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