Hoon Kim1, Dong-Kyu Jang2, Young-Min Han3, Jae Hoon Sung4, Ik Seong Park1, Kwan-Sung Lee5, Ji-Ho Yang6, Pil Woo Huh7, Young Sup Park3, Dal-Soo Kim8, Kyung-Do Han9. 1. Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea. 2. Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. Electronic address: argus3620@gmail.com. 3. Department of Neurosurgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. 4. Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea. 5. Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. 6. Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea. 7. Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea. 8. Department of Neurosurgery, Myong-Ji St. Mary's Hospital, Seoul, Korea. 9. Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Abstract
BACKGROUND: It remains controversial which bypass methods are optimal for treating adult moyamoya angiopathy patients. This study aimed to analyze the literature about whether different bypass methods affect differently outcome results of adult moyamoya patients with symptoms or hemodynamic instability. METHODS: A systematic search of the PubMed, Embase, and Cochrane Central databases was performed for articles published between 1990 and 2015. Comparative studies about the effect of direct or combined bypass (direct bypass group) and indirect bypass (indirect bypass group) in patients with moyamoya angiopathy at 18 years of age or older were selected. For stroke incidence at the end of the follow-up period, the degree of angiographic revascularization, hemodynamic improvement, and perioperative complication rates within 30 days, pooled relative risks were calculated between the 2 groups with a 95% confidence interval. RESULTS: A total of 8 articles (including 536 patients and 732 treated hemispheres) were included in the meta-analysis. There were no significant differences between the 2 groups when we compared the overall stroke rate, the hemodynamic improvement rate, or the perioperative complication rate at the end of the follow-up period. The direct bypass group, however, had a lower risk than the indirect bypass group for obtaining a poor angiographic revascularization rate (risk ratio, 0.35; 95% confidence interval, 0.15-0.84; P = 0.02). CONCLUSIONS: The current meta-analysis suggests that the direct or combined bypass surgical method is better for angiographic revascularization in adult moyamoya patients with symptoms or hemodynamic instability. Future studies may be necessary to confirm these findings.
BACKGROUND: It remains controversial which bypass methods are optimal for treating adult moyamoya angiopathypatients. This study aimed to analyze the literature about whether different bypass methods affect differently outcome results of adult moyamoya patients with symptoms or hemodynamic instability. METHODS: A systematic search of the PubMed, Embase, and Cochrane Central databases was performed for articles published between 1990 and 2015. Comparative studies about the effect of direct or combined bypass (direct bypass group) and indirect bypass (indirect bypass group) in patients with moyamoya angiopathy at 18 years of age or older were selected. For stroke incidence at the end of the follow-up period, the degree of angiographic revascularization, hemodynamic improvement, and perioperative complication rates within 30 days, pooled relative risks were calculated between the 2 groups with a 95% confidence interval. RESULTS: A total of 8 articles (including 536 patients and 732 treated hemispheres) were included in the meta-analysis. There were no significant differences between the 2 groups when we compared the overall stroke rate, the hemodynamic improvement rate, or the perioperative complication rate at the end of the follow-up period. The direct bypass group, however, had a lower risk than the indirect bypass group for obtaining a poor angiographic revascularization rate (risk ratio, 0.35; 95% confidence interval, 0.15-0.84; P = 0.02). CONCLUSIONS: The current meta-analysis suggests that the direct or combined bypass surgical method is better for angiographic revascularization in adult moyamoya patients with symptoms or hemodynamic instability. Future studies may be necessary to confirm these findings.
Authors: Markus Kraemer; Rusen Karakaya; Toshinori Matsushige; Jonas Graf; Philipp Albrecht; Hans-Peter Hartung; Peter Berlit; Rudolf Laumer; Frank Diesner Journal: J Neurol Date: 2018-08-28 Impact factor: 4.849