Clinical Features, Surgical Treatment, and Long-Term Outcome of a Multicenter Cohort of Pediatric Moyamoya

Zheng, Jun; Yu, Le‐Bao; Dai, Kefang; Zhang, Yan; Wang, Rong; Zhang, Dong

doi:10.3389/fneur.2019.00014

Cited by 24 publications

(22 citation statements)

References 27 publications

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“…Three articles were excluded since they did not compare one or more of the preplanned outcomes. Finally, there were 18 articles involved in our quantitative synthesis (Bang et al., 2012 ; Bot et al., 2018 ; Choi et al., 2013 ; Deng et al., 2018 ; Golby et al., 1999 ; Huang et al., 2015 ; Kawaguchi et al., 2000 ; Kim et al., 2012 ; Lee et al., 2012 ; X. Liu et al., 2013 ; Matsushima et al., 1998 , 1992 ; Mesiwala et al., 2008 ; Zhai et al., 2018 ; M. Zhao et al., 2017 ; Y. Zhao et al., 2019 , 2018 ; Zheng et al., 2019 ).…”

Section: Resultsmentioning

confidence: 99%

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A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

et al. 2021

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Purpose: Ischemia is one of the most familiar complications in the different procedures for moyamoya disease (MMD), but the optimal surgical approaches for MMD remain unknown. We aimed to evaluate the efficiency of various surgical treatments.Methods: A literature search word was performed through four databases such as Cochrane Library, Web of Science, PubMed, and EMBASE for the literature published until May 2021. The I 2 statistic was used to assess heterogeneity. A random/fixedeffects model was used to pool.Results: There are a total of 18 studies including three surgical treatments such as including indirect, direct, and combined bypass in this study. The result revealed that indirect bypass was related to a higher incidence of recurrence stroke compared to the direct and combined bypass treatment (p = .001). Furthermore, the cases undergoing direct bypass were associated with a better angiographic change than the indirect bypass (OR = 3.254, p = .013). Conclusion:This meta-analysis demonstrated a positive effect of using the direct and combined bypass to treat MMD compared to indirect bypass due to their lower rates of recurrence stroke. K E Y W O R D Scombined bypass, direct bypass, indirect bypass, moyamoya disease INTRODUCTIONMoyamoya disease (MMD) was first reported by Japanese literature in 1957 (Suzuki & Takaku, 1969), which was characterized by progressive stenosis and eventual occlusion of the major intracranial arteries in the proximity of the distal ends of internal carotid arteries (ICA). As a result of progressive blockage of the major vessels, networks of small collateral vessels develop and show a "puff of smoke" appearance on angiography, for which the name "moyamoya" (Japanese word for "puff of smoke") was coined (Suzuki & Takaku, 1969). MMD can cause strokes including two main phenotypes in populations: the This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2021 The Authors. Brain and Behavior published by Wiley Periodicals LLC ischemic and hemorrhagic types. Severe neuropsychological disorders, including cognitive decline, depression, and anxiety that cause the quality of life decline are also the main clinical feature of MMD (Cho et al., 2015). It is reported that MMD is common in East Asian people such as Korean and Japanese, as compared to Western Hemisphere people. According to a survey performed in Japan, the prevalence of MMD was approximately 3.16/100,000 (Wakai et al., 1997). The Japanese literature has reported that the prevalence of MMD had doubled from 3900 in 1994 to 7700 in 2003 (Kainth et al., 2013). The serious complications of MMD can lead to worse clinical outcomes and an increased mortality rate in MMD patients. Despite the Brain Behav.

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Section: Resultsmentioning

confidence: 99%

“…The recurrence strokes between the CB and DB group are compared in six studies (Bot et al., 2018 ; Golby et al., 1999 ; Huang et al., 2015 ; Lee et al., 2012 ; Matsushima et al., 1998 ; Zheng et al., 2019 ). The results indicated that there was no significant difference in the recurrence stroke ( p = .232).…”

Section: Resultsmentioning

confidence: 99%

A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

et al. 2021

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“…Unfortunately, due to the uneven follow-up duration, mRS scores were not compared between the groups for fear of incompatibility. Previous literature demonstrated that long-term functional outcomes were not significantly different between surgical modalities, despite the better revascularization provided by DB and combined revascularization (5, 24). This might be related to the relatively higher incidence of TIAs, which did not lead to significant neurological deterioration of neurological status, than cerebral infarctions during follow-up.…”

Section: Discussionmentioning

confidence: 94%

Comparison of Long-Term Effect Between Direct and Indirect Bypass for Pediatric Ischemic-Type Moyamoya Disease: A Propensity Score-Matched Study

Zhao

et al. 2019

Front. Neurol.

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Objectives: This study aimed to compare the postoperative risks and long-term effects between direct bypass surgery (DB) and indirect bypass (IB) surgery for pediatric patients with ischemic-type moyamoya disease (MMD). Method: Pediatric patients (under or equal to 18 years old) who were diagnosed as MMD and given surgical treatments at our center between 2009 and 2015 were retrospectively reviewed from a prospective database. Pediatric hemorrhagic-type MMD patients and those who did not undergo digital subtraction angiography (DSA) were excluded. Patients who underwent DB were matched with patients who underwent IB using 1:1 propensity score matching. Postoperative complications, recurrent ischemic stroke events and modified Rankin Scale (mRS) scores at the last follow-up were compared between the matched pairs. Results: A total of 223 pediatric patients were screened, and 138 patients (DB:34, IB:104) were considered for the propensity score match. Thirty four pairs were obtained. Nine patients had postoperative complications, including 6 (17.6%) in the DB group and 3 (8.8%) in the IB group ( P = 0.476). The mean follow-up period was 71.9 ± 22.2 months for the DB group and 60.2 ± 24.3 months for the IB group ( P = 0.041). Kaplan-Meier analysis showed a longer stroke-free time in the DB group than in the IB group ( P = 0.025). At last follow-up, good neurological status (mRS ≤ 1) was achieved in 32 (94.1%) of the DB group and 34 (100.0%) of the IB group. MRS score at last follow-up were significantly lower than at time of admission (all pts: 1.09 ± 0.45 vs. 0.28 ± 0.51, P < 0.001; DB group: 1.12 ± 0.48 vs. 0.32 ± 0.59, P < 0.001; IB group: 1.06 ± 0.42 vs. 0.24 ± 0.43, P < 0.001). Conclusion: Both techniques were effective in improving the neurological status of pediatric ischemic-type MMD patients, and direct bypass surgery might be more superior in preventing recurrent ischemic strokes in the short-term.

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“…Hyperhomocysteinemia is a risk factor for middle cerebral artery stenosis (16), and is recognised to be associated with the presence and severity of systemic atherosclerosis (6). (19,32), this finding suggests room for improvement in the clinical management of MMD patients in China.…”

Section: █ Discussionmentioning

confidence: 99%

Hyperhomocysteinemia independently associated with adult moyamoya disease: hospital based study of 237 patients

Zhang

Fu²,

Zeng³

et al. 2020

Turkish Neurosurgery

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To clarify the risk factors for adult moyamoya disease (MMD) in patients from South China. MATERIAL and METHODS: We prospectively studied adult patients who were diagnosed angiographically with MMD. The demographic profiles, medical history and clinical characteristics were compared between adult MMD and non-MMD stroke patients. Logistic regression analysis was used to determine the risk factors associated with adult MMD. RESULTS: A total of 35 adult MMD patients and 202 adults patients with non-MMD stroke were included. Of the 35 MMD patients, bilateral MMD occurred in 48.6% and bypass surgery was performed in 28.6%; these figures were significantly lower than those reported in patients from Korea and the United States (p<0.05). After adjusting for baseline demographics and potential confounders, multivariate logistic regression analysis was conducted, which showed that the plasma homocysteine level (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.06-1.14) and occupation as a technological worker (OR: 4.23; 95% CI: 1.65-10.89) were independently associated with adult MMD. CONCLUSION: Hyperhomocysteinemia and type of occupation were found to be independent risk factors for adult MMD in patients from South China. However, there is still a need for further research to clarify the pathogenesis of MMD. Given the lack of understanding about the risk factors and prevention measures for MMD, we suggest bypass surgery be used for MMD treatment in clinical practice in China to achieve more desirable effects in the management of the disease.

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Clinical Features, Surgical Treatment, and Long-Term Outcome of a Multicenter Cohort of Pediatric Moyamoya

Cited by 24 publications

References 27 publications

A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

A meta‐analysis of comparisons of various surgical treatments for moyamoya diseases

Comparison of Long-Term Effect Between Direct and Indirect Bypass for Pediatric Ischemic-Type Moyamoya Disease: A Propensity Score-Matched Study

Hyperhomocysteinemia independently associated with adult moyamoya disease: hospital based study of 237 patients

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