{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:38:43Z","timestamp":1790091523894,"version":"4.0.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Cerebral revascularization surgery (CRS) has been used to prevent stroke in children with sickle cell disease (SCD) and cerebral vasculopathy (e.g., moyamoya syndrome). While results suggest that it may be an effective treatment, surgical indications have not been well defined. This study sought to determine indications for offering revascularization surgery in centers with established sickle cell programs in the US.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Three sequential surveys utilizing the Delphi methodology were administered to neurosurgeons participating in the Stroke in Sickle Cell Revascularization Surgery study. Respondents were presented with clinical scenarios of patients with SCD and varying degrees of ischemic presentation and vasculopathy, and the group\u2019s agreement to offer surgical revascularization was measured. Consensus was defined as \u2265 75% similar responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The response rate to all 3 surveys was 100%. Seventeen neurosurgeons from 16 different centers participated. The presence of moyamoya collaterals (MMCs) and arterial stenosis matching an ischemic distribution yielded the strongest recommendations to offer surgery. There was consensus to offer revascularization in the presence of MMCs and at least 50% arterial stenosis matching an ischemic distribution. In contrast, there was no consensus to offer revascularization with 50%\u201370% stenosis not matching an ischemic presentation in the absence of MMCs. The presence of the ivy sign in the distribution of the stenotic artery also contributed to the consensus to offer surgery in certain scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>There were several clinical scenarios that attained consensus to offer surgery; the strongest was moderate to severe arterial stenosis that matched the distribution of ischemic presentation in the presence of MMCs. Radiological findings of decreased cerebral flow or perfusion also facilitated attaining consensus to offer surgery. The findings of this study reflect expert opinion about questions that deserve prospective clinical research. Determination of indications for CRS can guide clinical practice and aid the design of prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.5.peds2426","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T00:10:56Z","timestamp":1721779856000},"page":"402-413","source":"Crossref","is-referenced-by-count":3,"title":["Indications for cerebral revascularization for moyamoya syndrome in pediatric sickle cell disease determined by Delphi methodology"],"prefix":"10.3171","volume":"34","author":[{"given":"Adam P.","family":"Robert","sequence":"first","affiliation":[{"name":"Division of Pediatric Neurosurgery, University of Florida College of Medicine\u2013Jacksonville and Wolfson Children\u2019s Hospital, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo A.","family":"Hanel","sequence":"additional","affiliation":[{"name":"Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. David","family":"Adelson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Shan","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and Pediatric Neurosurgery, University of Pennsylvania School of Medicine, Children\u2019s Hospital of Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Grabb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Mercy Hospital, Kansas City, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Greene","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital of Alabama, Birmingham, Alabama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nationwide Children\u2019s Hospital, Columbus, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suresh N.","family":"Magge","sequence":"additional","affiliation":[{"name":"CHOC Neuroscience Institute, Children\u2019s Health of Orange County, Orange, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neena I.","family":"Marupudi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Children\u2019s Hospital of Michigan, Detroit, Michigan;"},{"name":"Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Piatt","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Nemours Children\u2019s Hospital Delaware, Wilmington, Delaware;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"De Oliveira Sillero","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Boston, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jodi","family":"Smith","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Peyton Manning Children\u2019s Hospital, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer M.","family":"Strahle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Washington University School of Medicine, Washington University in St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhakar","family":"Vadivelu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Wellons","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Division of Pediatric Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wrubel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Healthcare of Atlanta, Egleston Hospital, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asmaa","family":"Hatem","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, University of Florida College of Medicine\u2013Jacksonville and Wolfson Children\u2019s Hospital, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciarra","family":"Moody","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, University of Florida College of Medicine\u2013Jacksonville and Wolfson Children\u2019s Hospital, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina H.","family":"Han","sequence":"additional","affiliation":[{"name":"University of Florida College of Medicine, Gainesville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Montaser","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicklaus","family":"Millican","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Pederson","sequence":"additional","affiliation":[{"name":"Superior Medical Experts, St. Paul, Minnesota;"},{"name":"Nested Knowledge, St. Paul, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra S.","family":"Dain","sequence":"additional","affiliation":[{"name":"Division of Hematology, Children\u2019s Hospital of Philadelphia, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren A.","family":"Beslow","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Pediatrics, Division of Neurology, Children\u2019s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp R.","family":"Aldana","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, University of Florida College of Medicine\u2013Jacksonville and Wolfson Children\u2019s Hospital, Jacksonville, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"N Engl J Med","first-page":"5","article-title":"Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography","volume":"339","author":"Adams RJ","year":"1998","unstructured":"Adams RJ, McKie VC, Hsu L,  Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. 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