Intra-individual comparison of long-term outcomes between combined and indirect bypass surgery in adult moyamoya disease

• DOI: 10.1007/s00701-024-06391-6
• Publication Date: 2025-01-09T12:29:30Z
• Authors: Yuwhan Chung; Jeong Eun Kim; Hyun-Seung Kang; Tae Young Kim; Jin Chul Paeng; Won-Sang Cho; Sung Ho Lee; Eun Jin Ha; Kangmin Kim
• Keywords: Moyamoya Disease; Bypass surgery; Acetazolamide; Stroke

Abstract Purpose Bypass surgery is regarded as the standard treatment option for symptomatic and hemodynamically unstable moyamoya disease (MMD). However, there ongoing debate about most effective type of bypass surgery. We aimed to analyze long-term outcomes combined indirect bypasses MMD patients through intra-individual comparisons. Methods Of 896 who underwent 1084 surgeries between 2007 2021, 24 with on one side other were ultimately enrolled in this study. Clinical, angiographic hemodynamic retrospectively evaluated. Results Three asymptomatic strokes (12.5%) occurred within 30 postoperative days each group. Postoperative after 3 hemorrhagic events 1 cerebral infarction, only bypass, while no stroke hemispheres treated bypass. The revascularization area relative supratentorial was significantly greater than both short-term periods (64.9% versus 43.9% 75.7% 54.9% long-term; P < .001, respectively). Hemodynamic showed increases acetazolamide-challenged blood flow (CBF acz ) during follow-up ( = .04) basal CBF bas .014 .009, respectively) Conclusion Combined may be a more based its higher favorable results compared same patient.