TABLE 1.
Clinical Presentations and Outcomes of 8 Patients Undergoing WASEDS Procedure
| Patient | Age, y, sex | Additional diagnosis | Presenting symptoms | Surgical history | WASEDS | Follow-up (mo) | Outcome | Surgical complications |
|---|---|---|---|---|---|---|---|---|
| 1 | 6, F | – | Left hemiparesis; right frontal, parietal, temporal, and occipital ischemic infarcts | Bilateral EDAS, 3 y prior | Bilateral, 1 wk apart | 126 | No new CVA/TIA; unchanged baseline hemiparesis; subjective improvement in cognition, behavior and school performance at 6 wk | None |
| 2 | 18, F | – | Headache, vertigo, intermittent dystonia | Left EDAS, 3 y prior | Left | 92 | No new CVA/TIA; complete resolution of symptoms | None |
| 3 | 25, F | – | Left hemiparesis, monthly TIAs | Bilateral EDAS, 9 y prior | Right | 44 | No new CVA; significant reduction of TIAs: preoperative: several prolonged episodes of motor TIAs per week. Postoperative: 1 mild episode per year, maybe suggestive of migraine | None |
| 4 | 3, F | Sickle cell | Left hemiparesis; right frontal and lacunar ischemic infarcts | None | Bilateral, 3 mo apart | Left 87, right 72 | No new CVA/TIA; subjective improvement in school performance at 3 mo | Inflicted wound dehiscence resulting in superficial infection requiring wound revisions |
| 5 | 4, F | Down syndrome | Left hemiparesis; multifocal ischemic infarcts in bilateral hemispheres | None | Bilateral, same day | 15 | No new CVA/TIA; improvement in left hemiparesis; subjective improvement in vocabulary and school performance at 4 mo | None |
| 6 | 2, F | Down syndrome | Left hemiparesis; right frontal ischemic infarct | None | Bilateral, same day | 66 | No new CVA; single TIA concurrent with dehydration/gastrointestinal illness; improvement of left hemiparesis; subjective improvement in language and vocabulary at 1 mo | Pseudomeningocele requiring temporary lumboperitoneal shunt |
| 7 | 13, M | Autism | TIAs (expressive aphasia), headaches | None | Bilateral, same day | 43 | No new CVA; headaches and speech improved; 1 delayed TIA referable to right hemisphere resolved with increased aspirin therapy (Figure 2); subjective improvement in writing, speech, and behavior at 6 wk | Limited superficial wound swelling suggesting infection resolved with oral antibiotics |
| 8 | 3, M | – | Delayed language development, frequent anger spells, and intractable headaches | None | Bilateral, 4 mo apart | Left 17, right 13 | No new CVA/TIA; improved language skills, progressive improvement then complete resolution of headaches, and behavioral problems | Pseudomeningocele requiring temporary lumboperitoneal shunt |
CVA, cerebrovascular accident, EDAS, encephalo-duro-arterio-synangiosis; TIA, transient ischemic attack; WASEDS, wide arterial sparing encephalo-duro-synangiosis.