• Yawei Yan, Yunjie Li, Liangjiang Huang, and Suming Zhang.
• Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
• World Neurosurg. 2019 Apr 1; 124: 161170161-170.

ObjectiveTo evaluate the outcomes of bypass surgery for adult moyamoya and compare different surgical modalities by performing a comprehensive meta-analysis of relevant studies.MethodsA systematic literature search was performed and articles regarding different treatments for adult patients with moyamoya were included. Odds ratios (ORs) were calculated to evaluate stroke recurrence, mortality, perioperative complications, and angiographic revascularization among different surgical methods and conservative treatment (CT).ResultsA total of 17 studies with 2224 adult patients with moyamoya were included in the meta-analysis. Compared with CT, surgical revascularization significantly decreased the future stroke events in the total population ([OR] 0.404; 95% confidence interval [CI] 0.279-0.585; P < 0.001) and in the hemorrhagic-onset patients as well (OR 0.259; 95% CI 0.138-0.486; P < 0.001). However, for those patients with moyamoya and ischemia, there was no significant difference for future stroke events between the bypass and CT groups (OR 0.470; 95% CI 0.140-1.579; P = 0.222). Bypass also showed no mortality reduction compared with CT (OR 0.372; 95% CI 0.120-1.154; P = 0.087). For different surgical techniques, no differences for future stroke events, mortality, and perioperative complications were found between direct bypass and indirect bypass, whereas the degree of angiographic revascularization was better in the direct bypass group than in the indirect group (OR 4.720; 95% CI 1.222-18.230; P = 0.024).ConclusionsThe bypass treatment was superior to conservative treatment in preventing recurrent stroke in adult patients with moyamoya, especially in those with a hemorrhagic onset. Direct bypass is associated with better revascularization results compared with indirect bypass.Copyright © 2019 Elsevier Inc. All rights reserved.

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