Qifeng Li1, Yalong Gao1, Wenqiang Xin1, Ziwei Zhou1, Hongtao Rong1, Yafei Qin2, Ke Li1, Yuan Zhou1, Jiwei Wang3, Jianhua Xiong1, Xinlong Dong1, Mengchen Yang1, Yixin Liu4, Jun Shen5, Guangen Wang6, Aiguo Song7, Jianning Zhang8. 1. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, P. R. China; Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin Neurological Institute, Tianjin, P. R. China. 2. Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin Neurological Institute, Tianjin, P. R. China. 3. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, P. R. China; Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin Neurological Institute, Tianjin, P. R. China; Department of Neurology, Tianjin Huanhu Hospital, Tianjin, P. R. China. 4. Department of Clinical Immunology, School of Medical Laboratory, Tianjin Medical University, Tianjin, P. R. China. 5. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, P. R. China; Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin Neurological Institute, Tianjin, P. R. China; Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, P. R. China. 6. Department of Intensive Care Unit, Shexian Hospital, Handan, Hebei, P. R. China. 7. Department of Neurology, Shexian Hospital, Handan, Hebei, P. R. China. 8. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, P. R. China; Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System, Ministry of Education in China and Tianjin, Tianjin Neurological Institute, Tianjin, P. R. China. Electronic address: jianningzhang@hotmail.com.
Abstract
OBJECTIVE: The purpose of this study was to evaluate the efficacy of surgical revascularization versus conservative treatment and different surgical modalities, in order to provide evidence for the patient with moyamoya disease (MMD) to choose the appropriate treatment. METHODS: We comprehensively searched PubMed, Embase, Web of Science, and the Cochrane Library for articles published regarding MMD treatment. If the I2 value, which evaluated the heterogeneity, was <50%, a fixed-effect model was used; if not, a random effect model was applied. RESULTS: Twenty-seven articles were included in the meta-analysis. The surgery group is more advantageous in reducing the risk of future stroke events than conservative treatment in MMD patients (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.20-0.33, P < 0.001). In addition, the surgical group also had an advantage in terms of increased cerebral perfusion (OR 7.16, 95% CI 3.28-15.64, P < 0.001) and death due to rebleeding (OR 0.27, 95% CI 0.10-0.72, P < 0.01). Direct surgery showed a significant efficacy over indirect surgery (OR 2.03, 95% CI 1.32-3.13, P < 0.01). No obvious difference was found between the direct and indirect bypass subset (OR 0.76, 95% CI 0.51-1.14, P = 0.185). Angiographic results in patients undergoing direct bypass surgery are more pronounced (OR 0.20, 95% CI 0.06-0.67, P < 0.01). CONCLUSIONS: In patients with symptomatic moyamoya disease, bypass surgery is more effective than conservative treatment to prevent future strokes. In surgical patients, direct bypass seems to reduce the risk of stroke more than an indirect bypass.
OBJECTIVE: The purpose of this study was to evaluate the efficacy of surgical revascularization versus conservative treatment and different surgical modalities, in order to provide evidence for the patient with moyamoya disease (MMD) to choose the appropriate treatment. METHODS: We comprehensively searched PubMed, Embase, Web of Science, and the Cochrane Library for articles published regarding MMD treatment. If the I2 value, which evaluated the heterogeneity, was <50%, a fixed-effect model was used; if not, a random effect model was applied. RESULTS: Twenty-seven articles were included in the meta-analysis. The surgery group is more advantageous in reducing the risk of future stroke events than conservative treatment in MMD patients (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.20-0.33, P < 0.001). In addition, the surgical group also had an advantage in terms of increased cerebral perfusion (OR 7.16, 95% CI 3.28-15.64, P < 0.001) and death due to rebleeding (OR 0.27, 95% CI 0.10-0.72, P < 0.01). Direct surgery showed a significant efficacy over indirect surgery (OR 2.03, 95% CI 1.32-3.13, P < 0.01). No obvious difference was found between the direct and indirect bypass subset (OR 0.76, 95% CI 0.51-1.14, P = 0.185). Angiographic results in patients undergoing direct bypass surgery are more pronounced (OR 0.20, 95% CI 0.06-0.67, P < 0.01). CONCLUSIONS: In patients with symptomatic moyamoya disease, bypass surgery is more effective than conservative treatment to prevent future strokes. In surgical patients, direct bypass seems to reduce the risk of stroke more than an indirect bypass.
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