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Hemorrhagic Moyamoya Disease Treatment: A Network Meta-Analysis

Jiayue Ding1, Da Zhou1, Eric Eugene Paul Cosky2

  • 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China; China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China; Advanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.

World Neurosurgery
|June 23, 2018
PubMed
Abstract

Insights

Surgical revascularization, particularly direct bypass, is more effective than conservative treatment for preventing recurrent strokes in hemorrhagic moyamoya disease (MMD). It reduces both ischemic and hemorrhagic stroke recurrence but does not impact mortality rates.

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.
Keywords:
Hemorrhagic strokeMoyamoya diseaseTherapy

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