TABLE 2.
Literature Review of Direct and Indirect Revascularization Options and Their Outcomes for Moyamoya Disease
| Paper | Country | Intervention | No. of patients (no. of hemispheres) | Neurological outcome | Mean follow-up | Complications |
|---|---|---|---|---|---|---|
| Matsushima et al16 | Japan | STA-MCA + EMS (7) or EDAS alone (13) | 16 (20) | Symptoms disappeared in 3 (23%) sides with EDAS and 7 (100%) sides with direct bypass | 1 y | Increased TIAs in 2 EDAS patients and 1 direct bypass patients; 1 patient developed seizures |
| Mizoi et al22 | Japan | STA-MCA bypass ± EMS or EDAS; 1 patient with OA | 23 (41) | No ischemic or hemorrhagic events in 21 (91%) patients | 3.4 y | 2 (10%) pediatric patients with postoperative TIAs, 1 patient with skin flap necrosis |
| Ishikawa et al23 | Japan | STA-MCA bypass + EDAMS (48), EDAMS alone (16) | 34 (64) | Ischemic events persisted in 9 (56%) sides of the indirect group and in 5 (10%) sides in the combined group | 6.6 y | Perioperative ischemic events in 11 (17%) surgeries |
| Sakamoto et al24 | Japan | STA-MCA double anastomoses with EMS | 10 (19) | No patients with any significant postoperative ischemic episodes | 4 y | 4 patients had minor TIA within 1 month of surgery associated with hyperventilation |
| Matsushima et al25 | Japan | EDAS (18), EDAS + EMS (35) STA-MCA bypass with EMS (19) | 50 (72) | Symptoms resolved in 56% EDAS, 63% EDAS + EMS, and 74% direct bypass | 1 y | 1 patient had stroke after EDAS, 2 patients had EDH after MCI, 2 patients had stroke after direct bypass |
| Suzuki et al26 | Japan | STA-MCA bypass + EDAS, EMS, and burr holes (20), EDAS + EMS and burr holes (10), STA-MCA bypass on 1 side and EDAS on the other (6) | 36 (NRa) | TIA frequency decreased and completely disappeared within 1 y in 25 of 31 patients (81%). Symptoms were less frequent in the remaining 6 patients | NRa | 1 patient had complete stroke after indirect bypas, initial patients with skin necrosis |
| Golby et al27 | USA | STA-MCA bypass ± EDAS (19), MMA-MCA bypass (1), omental transposition (1) | 12 (21) | Neurological conditions stable to improved in all patients | 35 mo | None |
| Kim et al28 | Korea | Bifrontal EGPS with EDAS or EMS | 67 (NRa) | Complete disappearance of TIA in 63% | 21.4 mo | 3 patients had infarction because of damage of the draining vein into the superior sagittal sinus, 1 patient with postoperative arterial ischemic infarct, 1 patient with osteomyelitis of bone flap |
| Scott et al3 | USA | Pial synangiosis | 143 (271) | Of 126 patients with >1 y follow-up 7 patients had late-onset neurological problems, 6 patients required salvage surgeries | 5.1 y | 11 patients (7.7%) had stroke and 3 patients had severe TIAs within 30 days of surgery, 4 patients SDH, 1 patient died from IPH |
| Kim et al, 200729 | Korea | EDAS (16), EDAMS (8), STA-MCA bypass with EDAMS (12) | 24 (36) | Excellent to good results in 67%, 80% with EDAMS, and 100% with STA-MCA-EDAMS | NRa | None |
| Park et al17 | Korea | EDAS with bifrontal EGPS | 17 (NRa) | Excellent to good results in 15 patients (88.2%) | 11.5 mo | 1 patient with subgaleal/subdural hematoma resulting in poor revascularization |
| Tripathi et al18 | India | EDAS | 8 (15) | No episode of stroke or TIA for any patients | 2 y | 1 patient developed seizures temporarily postoperatively |
| Kim et al19 | Korea | EDAS + EGPS | 410 (NRa) | 81% of patients had a favorable clinical outcome | 61 mo | 2 patients died (0.5%), 15% had postoperative strokes, 6% had wound complications, 4% had EDH, 2% had SDH, 0.5% had IPH |
| Ng et al20 | UK | STA-MCA (49), EDAS (82) | 73 (134) | 5 patients (3.8%) had clinical or radiological acute ischemic symptoms. 79.2% had resolved or improved TIA symptoms | 2.8 y | 3 patients had intracranial hemorrhage |
| Montaser et al21 | USA | PiPeD revascularization | 21 (25) | No postoperative strokes. Radiographic revascularization in 20/22 hemispheres (90.9%) | 1 patient (4.7%) had superficial infection |
EDAS, encephalo-duro-arterio-synangiosis; EGPS, encephalogaleoperiosteal-synangiosis; EMS, encephalo-myo-synangiosis; IPH, intraparenchymal hematoma; MCA, middle cerebral artery; MMA, middle meningeal artery; OA, occipital artery; PiPeD, Pial pericranial dural; SDH, subdural hematoma; STA, superficial temporal artery; TIA, transient ischemic attack.
a
NR means information not reported.