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

Yahui Zhao1, Junlin Lu1, Shaochen Yu1

  • 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Frontiers in Neurology
|August 17, 2019
PubMed

Insights

Direct bypass surgery may offer better protection against recurrent strokes in pediatric moyamoya disease patients compared to indirect bypass. Both methods effectively improve neurological function in children with ischemic-type moyamoya disease.

Area of Science:

  • Neurosurgery
  • Pediatric Neurology
  • Vascular Surgery

Background:

  • Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the intracranial arteries.
  • Ischemic-type MMD in pediatric patients presents unique challenges for surgical management.
  • Surgical revascularization aims to restore blood flow and prevent ischemic events.

Purpose of the Study:

  • To compare the postoperative risks and long-term outcomes of direct bypass (DB) versus indirect bypass (IB) surgery in pediatric patients with ischemic-type MMD.
  • To evaluate complication rates, recurrent ischemic stroke events, and neurological status post-surgery.

Main Methods:

  • Retrospective review of a prospective database of pediatric MMD patients (under 18) treated between 2009-2015.
  • Exclusion of hemorrhagic-type MMD and patients without digital subtraction angiography (DSA).
  • 1:1 propensity score matching to compare DB and IB groups, analyzing postoperative complications, stroke recurrence, and modified Rankin Scale (mRS) scores.

Main Results:

  • Thirty-four matched pairs of patients (DB:34, IB:34) were analyzed.
  • Postoperative complication rates were similar between groups (DB: 17.6%, IB: 8.8%, P=0.476).
  • Direct bypass surgery demonstrated a significantly longer stroke-free period (P=0.025) and a longer mean follow-up duration (P=0.041).

Conclusions:

  • Both direct bypass and indirect bypass surgery are effective in improving neurological status in pediatric ischemic-type MMD.
  • Direct bypass surgery may offer superior protection against recurrent ischemic strokes in the short-term.
  • Further research may elucidate long-term superiority and optimal surgical strategies.
Keywords:
direct bypassindirect bypasslong-term outcomemoyamoya diseasepediatric MMD

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