Anti-clotting drugs, such as aspirin, can help prevent the formation of blood clots in children who are at risk for mini-strokes and strokes due to cerebrovascular disease.

Calcium channel blockers are a type of medication prescribed to relieve some symptoms of Moyamoya disease. These drugs prevent calcium from entering the cells of the heart and blood vessel walls. This lowers the child’s blood pressure, which in turn can reduce severe headaches and “mini-strokes” common among children with Moyamoya.

• Endovascular embolization, which uses glue or coils to plug a lesion in the artery caused by an aneurysm, arteriovenous malformation or other abnormal blood vessels in the brain. The goal is to cut off the blood supply in the problem area and reduce the risk of rupture.
• Stent placement, which involves inserting a tiny mesh device inside an artery to keep blood flowing. Stenting is sometimes used to prevent stroke in patients with venous hypertension or pseudotumor.
• Selective intra-arterial chemotherapy for tumors of the head, neck and spine. Cincinnati Children’s is one of the only pediatric hospitals in the United States offering this therapy.

Direct arterial bypass is a complex surgery to treat an artery that has been damaged, blocked or narrowed due to Moyamoya disease. This revascularization procedure, also known as “superficial temporal artery to middle cerebral artery (STA-MCA) bypass,” involves connecting a blood vessel from the scalp directly to a blood vessel on the outer surface of the brain. The goal is to create a new pathway for blood flow.

Indirect revascularization is a surgery used to encourage new blood vessel growth to the brain for patients with Moyamoya disease. It involves laying an artery, muscle or other tissue on the surface of the brain. Over time, new blood vessels form, improving blood flow to the brain. Indirect revascularization techniques include:

• Pial synangiosis
• Dural inversion
• Encephaloduroarteriosynangiosis (EDAS)
• Encephalomyosynangiosis (EMS)
• Omental transposition/transfer

Deep brain stimulation (DBS) is used to treat dystonia (tremors) that sometimes occur when a child has a cerebrovascular disease such as chronic stroke or an arteriovenous malformation.

Performed by a neurosurgeon, this minimally invasive procedure involves placing a stimulation electrode on abnormal brain tissue. This therapy can change how the tissue functions and can help control tremors and improve movement. Our neurosurgeons perform this procedure using intraoperative magnetic resonance imaging, which provides real-time guidance during surgery. DBS is reversible and adjustable, and does not damage brain tissue. 

Very few medical centers in the United States provide a comprehensive DBS program for children and adolescents. We do. Our team collaborates with specialists at the Cincinnati Children’s Dystonia and Surgical Movement Disorders Clinic to make sure children receive comprehensive care before and after the surgery.