Hemorrhagic Moyamoya Disease Treatment: A Network Meta-Analysis

Area of Science:

• Neurosurgery
• Neurology
• Vascular Surgery

Background:

• Hemorrhagic moyamoya disease (MMD) management strategies are debated.
• Optimal therapy for MMD with hemorrhage requires further investigation.

Purpose of the Study:

• To investigate the optimal therapeutic strategy for hemorrhagic moyamoya disease.
• To compare the efficacy of surgical revascularization versus conservative treatment.

Main Methods:

• A systematic literature search was conducted using PRISMA guidelines across PubMed, Embase, and Cochrane databases.
• A network meta-analysis of 9 articles, including 1050 patients, was performed using R software.

Main Results:

• Surgical revascularization significantly reduced recurrent stroke events (OR, 0.39) compared to conservative treatment.
• Direct bypass surgery showed a lower incidence of recurrent stroke than conservative or indirect bypass (OR, 0.30 and 0.39, respectively).
• Surgical revascularization did not significantly reduce mortality (OR, 0.53).

Conclusions:

• Surgical revascularization, especially direct bypass, is suggested as the optimal strategy for hemorrhagic MMD.
• Direct bypass appears superior to indirect bypass and conservative management in preventing recurrent strokes.