PMID- 37877987
OWN - NLM
STAT- MEDLINE
DCOM- 20240304
LR  - 20240304
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 140
IP  - 3
DP  - 2024 Mar 1
TI  - Effectiveness of indirect revascularization for adult hemorrhagic moyamoya 
      disease: a 10-year follow-up study.
PG  - 764-773
LID - 10.3171/2023.6.JNS23727 [doi]
AB  - OBJECTIVE: The optimal surgical approach for hemorrhagic moyamoya disease (hMMD) 
      continues to be a topic of debate. The authors' prior research demonstrated that 
      both combined and indirect revascularization were efficacious. However, questions 
      remain regarding the long-term prognosis consistency between these two 
      treatments. Therefore, the objective of this study was to evaluate and compare 
      the enduring effects of these surgical modalities on adult hMMD, extending the 
      findings of the authors' previous studies. METHODS: The authors recruited 
      patients diagnosed with hMMD between 2010 and 2015. The patients were categorized 
      into two groups: those who underwent combined revascularization (superficial 
      temporal artery-middle cerebral artery bypass alongside dural reverse 
      application) and those who underwent indirect revascularization 
      (encephaloduroarteriosynangiosis [EDAS]). The primary and secondary endpoints of 
      this study were instances of rebleeding, confirmed with CT scan, and death 
      resulting from rebleeding, respectively. The authors estimated rebleeding-free 
      and death-free survival rates by utilizing the Kaplan-Meier survival method. They 
      used Cox regression to adjust for confounders and to evaluate the effects of the 
      varying surgical modalities on the endpoints. RESULTS: After an average follow-up 
      period of 114 months, 35 patients (28.6%) experienced 40 rebleeding events, 
      yielding an average annual incidence of 3.5%. Of the 79 patients who received 
      combined revascularization, 17 (21.5%) experienced rebleeding events. Similarly, 
      of 43 patients who underwent EDAS, 18 (41.9%) experienced rebleeding events (p = 
      0.018). Most rebleeding instances occurred 61-120 months after surgery (21 
      patients [60%]), followed by 12-60 months (11 patients [31.4%]). Multivariate 
      survival analysis highlighted significant differences in surgical outcomes (HR 
      0.33, 95% CI 0.15-0.74, p = 0.007). The authors observed that 8 patients (10.1%) 
      died of rebleeding events in the combined group, as well as 10 patients (23.3%) 
      in the EDAS group. Despite the lack of a statistically significant difference in 
      mortality (p = 0.051), multivariable survival analysis found a significant 
      difference (HR 0.31, 95% CI 0.10-0.97, p = 0.044). CONCLUSIONS: High rebleeding 
      rates persist in adult hMMD patients, even after revascularization. Combined 
      revascularization proved superior to EDAS in preventing long-term rebleeding. In 
      contrast, EDAS alone did not display a clear effect on reducing long-term 
      rebleeding rates.
FAU - Zhang, Qihang
AU  - Zhang Q
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Yin, Zihan
AU  - Yin Z
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Zhu, Chenyu
AU  - Zhu C
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Li, Wenjie
AU  - Li W
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Zhu, Huan
AU  - Zhu H
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Wang, Peijiong
AU  - Wang P
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Zhang, Dong
AU  - Zhang D
AD  - 2Department of Neurosurgery, Beijing Hospital, Beijing, China.
FAU - Zhao, Jizong
AU  - Zhao J
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Zhang, Yan
AU  - Zhang Y
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
FAU - Liu, Xingju
AU  - Liu X
AD  - 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical 
      University, Beijing, China; and.
LA  - eng
PT  - Journal Article
DEP - 20230818
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
RN  - Moyamoya disease 1
SB  - IM
MH  - Adult
MH  - Humans
MH  - Follow-Up Studies
MH  - *Moyamoya Disease/diagnostic imaging/surgery
MH  - Vascular Surgical Procedures
MH  - *Cerebral Revascularization
OTO - NOTNLM
OT  - cerebrovascular disease
OT  - hemorrhage
OT  - moyamoya disease
OT  - neurosurgery
OT  - vascular disorders
EDAT- 2023/10/25 12:42
MHDA- 2024/03/04 06:42
CRDT- 2023/10/25 10:54
PHST- 2023/04/01 00:00 [received]
PHST- 2023/06/14 00:00 [accepted]
PHST- 2024/03/04 06:42 [medline]
PHST- 2023/10/25 12:42 [pubmed]
PHST- 2023/10/25 10:54 [entrez]
AID - 10.3171/2023.6.JNS23727 [doi]
PST - epublish
SO  - J Neurosurg. 2023 Aug 18;140(3):764-773. doi: 10.3171/2023.6.JNS23727. Print 2024 
      Mar 1.