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Complications associated with combined direct and indirect bypass in Moyamoya Disease: A meta-analysis

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Abstract

Bypass revascularization helps prevent complications in Moyamoya Disease (MMD). To systematically review complications associated with combined direct and indirect (CB) bypass in MMD and analyze differences between the adult and pediatric populations. A systematic literature review was conducted per PRISMA guidelines. PUBMED, Cochrane Library, Web of Science, and CINAHL, were queried from January 1980 to March 2022. Complications were defined as any event in the immediate post-surgical period of a minimum 3 months follow-up. Exclusion criteria included lack of surgical complication reports, non-English articles, and CB unspecified or reported separately. 18 final studies were included of 1580 procured. 1151 patients (per study range = 10—150, mean = 63.9) were analyzed. 9 (50.0%) studies included pediatric patients. There were 32 total hemorrhagic, 74 total ischemic and 16 total seizure complications, resulting in a rate of 0.04 (95% CI 0.03, 0.06), 0.7 (95% CI 0.04, 0.10) and 0.03 (95% CI 0.02, 0.05), respectively. The rate of hemorrhagic complications in the pediatric showed no significant difference from the adult subgroup (0.03 (95% CI 0.01—0.08) vs. 0.06 (95% CI 0.04—0.10, p = 0.19), such as the rate of ischemic complications (0.12 (95% CI 0.07—0.23) vs. 0.09 (95% CI 0.05—0.14, p = 0.40). Ischemia is the most common complication in CB for MMD. Pediatric patients had similar hemorrhagic and ischemic complication rates compared to adults.

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Authors and Affiliations

  1. School of Medicine, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Cidade Universitária, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-590, Brazil

    Sávio Batista, Livia V. de Abreu & Dillan Amaral

  2. Vanderbilt School of Medicine, Nashville, TN, USA

    Stefan Koester & Anthony E. Bishay

  3. Department of Neurosurgery, University of São Paulo, São Paulo, Brazil

    Raphael Bertani & Eberval Gadelha Figueiredo‬‬‬

  4. Department of Neurosurgery, Galeão Air Force Hospital, Rio de Janeiro, Brazil

    Dan Zimelewicz Oberman

  5. Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA

    Jhon E. Bocanegra-Becerra

  6. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Albert M. Isaacs & Michael Dewan

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Albert M. Isaacs, Anthony E. Bishay, Dillan Amaral, Jhon E. Bocanegra-Becerra, Livia V. Abreu, Michael Dewan, Sávio Batista and Stefan Koester. The first draft of the manuscript was written by Anthony E. Bishay, Dan Zimelewicz Oberman, Raphael Bertani, Sávio Batista and Stefan Koester, and all authors commented on previous versions of the manuscript. Supervision was coordinated by Eberval Gadelha Figueiredo. All authors read and approved the final manuscript.

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Correspondence to Livia V. de Abreu.

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Batista, S., Koester, S., Bishay, A.E. et al. Complications associated with combined direct and indirect bypass in Moyamoya Disease: A meta-analysis. Neurosurg Rev 47, 58 (2024). https://doi.org/10.1007/s10143-024-02285-4

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