Comparison of revascularization and conservative treatment for hemorrhagic moyamoya disease in East Asian Countries: a single-center case series and a systematic review with meta-analysis

Frontiers in Neurology

Neurology

Yi-Peng Dong¹  Cheng-jun Wang¹  Xiang-Sheng Zhang¹  Wu Tao¹  Jing Zhang¹  Xiang-Hua Zhang¹  Jun-Hua He² 

[1] Department of Neurosurgery, Beijing Friendship Hospital Affiliated With Capital Medical University, Beijing, China;Department of Neurosurgery, Zhejiang Provincial Tongde Hospital, Hangzhou, China;

关键词: revascularization;    conservative;    rebleeding;    ischemic;    mortality;    moyamoya disease;    hemorrhagic;   

DOI  :  10.3389/fneur.2023.1169440

 received in 2023-02-19, accepted in 2023-04-28,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectiveThe optimal treatment approach for hemorrhagic moyamoya disease (HMMD) remains a topic of debate, particularly regarding the comparative efficacy of revascularization versus conservative treatment. Our study, which included a single-center case series and a systematic review with meta-analysis, aimed to determine whether surgical revascularization is associated with a significant reduction in postoperative rebleeding, ischemic events, and mortality compared to conservative treatment among East Asian HMMD patients.MethodsWe conducted a systematic literature review by searching PubMed, Google Scholar, Wanfang Med Online (WMO), and the China National Knowledge Infrastructure (CNKI). The outcomes of surgical revascularization and conservative treatment, including rebleeding, ischemic events and mortality, were compared. The authors' institutional series of 24 patients were also included and reviewed in the analysis.ResultsA total of 19 East Asian studies involving 1,571 patients as well as our institution's retrospective study of 24 patients were included in the study. In the adult patients-only studies, those who underwent revascularization had significantly lower rates of rebleeding, ischemic events, and mortality compared to those who received conservative treatment (13.1% (46/352) vs. 32.4% (82/253), P < 0.00001; 4.0% (5/124) vs. 14.9% (18/121), P = 0.007; and 3.3% (5/153) vs. 12.6% (12/95), P = 0.01, respectively). In the adult/pediatric patients' studies, similar statistical results of rebleeding, ischemic events, and mortality have been obtained (70/588 (11.9%) vs. 103/402 (25.6%), P = 0.003 or <0.0001 in a random or fixed-effects model, respectively; 14/296 (4.7%) vs. 26/183 (14.2%), P = 0.001; and 4.6% (15/328) vs. 18.7% (23/123), P = 0.0001, respectively).ConclusionThe current single-center case series and systematic review with meta-analysis of studies demonstrated that surgical revascularization, including direct, indirect, and a combination of both, significantly reduces rebleeding, ischemic events, and mortality in HMMD patients in the East Asia region. More well-designed studies are warranted to further confirm these findings.

【 授权许可】

Unknown   
Copyright © 2023 Zhang, He, Zhang, Zhang, Wang, Dong and Tao.