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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(03): 445-451
DOI: 10.1055/s-0044-1787795
Original Article

Combined Direct and Indirect Revascularization for Adults with Moyamoya Disease: A Single-Center Retrospective Study

Ali Ayyad   *
1   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
4   Department of Neurosurgery, Saarland University Hospital, Homburg, Germany
,
Mohammed Maan Al-Salihi    *
2   Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, United States
,
Alaaeldin Ahmed
1   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
,
Amro Al Hajali
1   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
,
Firas Hammadi
1   Department of Neurosurgery, Hamad General Hospital, Doha, Qatar
,
Peter Horn
3   Hamad General Hospital, Doha, Qatar
› Author Affiliations Funding None.
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Abstract

Background Moyamoya vasculopathy is a rare neurological disease characterized by the progressive constriction of major intracranial vessels and secondary collateral formation. In the past decade, the popularity of combined bypass surgery has increased. They take advantage of the quick perfusion of direct bypass and collaterals ingrowth from indirect bypass.

Objective This study aimed to describe a single-center experience with surgical management of moyamoya disease (MMD) and moyamoya syndrome (MMS) over 7 years.

Materials and Methods In this retrospective medical records review, we enrolled patients diagnosed with MMD and MMS who were treated with combined surgical revascularization at the Hamad Medical Corporation center between 2015 and 2022. SPSS 26.0 was used to analyze the data.

Results A total of 20 patients were included, with 15% having MMS. The mean age was 37.4 ± 10.26 years, and 60% of them were males. The mean follow-up period was 13.6 months. The modified Rankin score was significantly decreased by 1.9 ± 2.1, p = 0.0001. Following surgery, no deficits were observed in 16 cases, whereas three were not improved, and one died. Following up on the stroke status, one patient developed a hemorrhagic stroke, and another showed right-side numbness. The postoperative status was substantially linked with the initial clinical presentation (p = 0.004).

Conclusion Combined direct and indirect surgical revascularization procedures have favorable outcomes in MMD and MMS patients. Additional rigorous, prospective, controlled, high-quality trials with large-sample are needed to support our results.

Keywords

moyamoya - direct bypass - indirect bypass - combined - revascularization

Authors' Contributions

All the authors have contributed equally to writing, editing, and reviewing the manuscript. All authors read and approved the final version of the manuscript.


* Equal contribution.


Supplementary Material



Publication History

Article published online:
12 June 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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