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The Management of Symptomatic Moyamoya Disease in Pediatric Patients: A Systematic Review and Meta-Analysis

Ataollah Shahbandi1, Shahab Aldin Sattari2, Tej D Azad2

  • 1Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran , Iran.

Neurosurgery
|November 19, 2024
PubMed

Insights

Surgical revascularization improves outcomes for pediatric moyamoya disease (MMD). Both direct/combined bypass and indirect bypass techniques are effective, with surgery reducing stroke risk compared to conservative management.

Area of Science:

  • Neurology
  • Neurosurgery
  • Pediatric Medicine

Background:

  • Optimal management for symptomatic pediatric moyamoya disease (MMD) remains unclear.
  • This study systematically reviews and analyzes surgical versus conservative treatment strategies.
  • It also compares direct/combined bypass (DB/CB) with indirect bypass (IB) techniques.

Purpose of the Study:

  • To compare the efficacy of surgical versus conservative management for pediatric MMD.
  • To evaluate the effectiveness of direct/combined bypass (DB/CB) versus indirect bypass (IB) techniques.
  • To identify optimal revascularization strategies for improving clinical outcomes in pediatric MMD patients.

Main Methods:

  • Systematic review and meta-analysis of studies from MEDLINE and PubMed (up to March 17, 2024).
  • Primary outcomes: follow-up ischemic stroke (surgical vs. conservative; DB/CB vs. IB).
  • Secondary outcomes: hemorrhagic events, transient ischemic attacks, seizures, functional outcomes (mRS), and symptom improvement.

Main Results:

  • Surgical management was associated with significantly lower odds of ischemic stroke (OR=0.33) and a trend towards fewer hemorrhagic events compared to conservative care.
  • Direct/combined bypass (DB/CB) showed a trend towards better Matsushima grade A compared to indirect bypass (IB) (OR=3.44).
  • No significant differences were found between DB/CB and IB for stroke, TIA, seizures, symptomatic improvement, or functional outcomes (mRS ≤2).

Conclusions:

  • Surgical revascularization offers superior clinical outcomes compared to conservative management in pediatric symptomatic moyamoya disease.
  • Both direct/combined bypass and indirect bypass techniques demonstrate comparable efficacy in preventing ischemic events.
  • Surgical flow augmentation, regardless of technique, appears beneficial for pediatric patients with symptomatic MMD.
Abstract

Keywords:
BypassMoyamoya diseasePediatricRevascularizationStrokeSurgery

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