Risk Factors Influencing Disease Onset and Surgical Outcomes in Moyamoya Disease

The aim of this study is to explore the risk factors associated with the onset and clinical progression of moyamoya disease (MMD), as well as the outcomes of combined revascularization surgery (RS).

A retrospective analysis was performed on the medical records of 226 individuals diagnosed with MMD who underwent combined RS at the Department of Neurosurgery in 2022. Binary logistic regression analysis was used to identify risk factors related to the occurrence of cerebral ischemia (CIS), postoperative complications, lateralization of MMD involvement, progression from unilateral to bilateral MMD, and disease severity in cases presenting with CIS. Surgical effectiveness was assessed during follow-up.

Hypertension (odds ratio [OR] = 1.816, 95% confidence interval [CI]: 1.031-3.197) and higher preoperative modified Rankin Scale scores (OR = 5.164, 95% CI: 1.145-23.295) were identified as independent risk factors for CIS. Male sex (OR = 4.219, 95% CI: 1.470-12.195) and age ≥ 50 years (OR = 3.979, 95% CI: 1.494-10.598) were independent predictors of postoperative complications following RS. No independent factors were associated with the affected side or bilateral progression of MMD (P > 0.05). Disease severity in patients with CIS was influenced by both Suzuki staging and age. The effective rate of RS at 3-6 months postoperatively was 96.46%.

Early intervention is recommended, particularly for male patients and those with modifiable risk factors such as hypertension. RS should ideally be performed during the early stages of Suzuki classification and before the age of 50 to reduce the risk of postoperative complications. For patients with advanced Suzuki stage or aged ≥ 50 years, comprehensive perioperative risk assessments and tailored postoperative management strategies are essential to ensure optimal surgical outcomes.