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

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY Neurosurgery Pub Date : 2024-11-14 DOI:10.1227/neu.0000000000003277

Ataollah Shahbandi, Shahab Aldin Sattari, Tej D Azad, Yuanxuan Xia, Kurt Lehner, Wuyang Yang, James Feghali, Rebecca A Reynolds, S Hassan A Akbari, Mari L Groves, Risheng Xu, Justin M Caplan, Chetan Bettegowda, Alan R Cohen, Judy Huang, Rafael J Tamargo, L Fernando Gonzalez

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Abstract

Background and objectives: The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD.

Methods: MEDLINE and PubMed were searched from inception to March 17, 2024. For analysis of surgical vs conservative treatment, the primary and secondary outcomes were follow-up ischemic stroke and intracranial hemorrhagic events, respectively. For analysis of DB/CB vs IB, the primary outcome was follow-up ischemic stroke, and secondary outcomes included follow-up transient ischemic attack, new or worsened seizures, symptomatic improvement, modified Rankin Scale score ≤2, and Matsushima grade A at the last follow-up.

Results: Twenty-two included studies yielded 1091 patients, with a median follow-up duration of 35.7 months. Regarding surgical vs conservative management, 428 patients were analyzed. Surgical treatment was associated with lower odds of ischemic stroke (odds ratios [OR] = 0.33 [95% CI, 0.11-0.97], P = .04), and intracranial hemorrhagic events tended to be lower with surgery (OR = 0.25 [0.06-1.03], P = .05). Regarding DB/CB techniques vs IB, 875 patients were analyzed. The groups had similar rates of ischemic stroke (OR = 0.79 [0.31-1.97], P = .61), transient ischemic attack (OR = 1.27[0.46-3.55], P = .64), new or worsened seizures (OR = 1.05[0.3-3.65], P = .93), symptomatic improvement (OR = 2.45[0.71-8.45], P = .16), and follow-up modified Rankin Scale ≤2 (OR = 1.21 [0.16-8.85], P = .85). CB was associated with higher Matsushima grade A relative to IB (OR = 3.44 [1.32-9.97], P = .01).

Conclusion: Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.

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小儿无症状莫亚莫亚病的治疗：系统回顾与元分析》。

背景和目的：无症状莫亚莫亚氏病（MMD）儿科患者的最佳治疗策略尚未明确。本系统综述和荟萃分析比较了手术与保守治疗、直接/联合分流术（DB/CB）与间接分流术（IB）对无症状莫亚莫亚氏病儿科患者的治疗效果：方法：检索了从开始到 2024 年 3 月 17 日的 MEDLINE 和 PubMed。对于手术治疗与保守治疗的分析，主要和次要结果分别为随访缺血性中风和颅内出血事件。对于 DB/CB 与 IB 的分析，主要结果是随访缺血性卒中，次要结果包括随访短暂性脑缺血发作、新的或恶化的癫痫发作、症状改善、修改后的 Rankin 量表评分≤2，以及最后一次随访时的松岛 A 级：22项研究共纳入1091名患者，中位随访时间为35.7个月。在手术治疗与保守治疗方面，共分析了 428 例患者。手术治疗与较低的缺血性卒中几率相关（几率比 [OR] = 0.33 [95% CI, 0.11-0.97]，P = .04），手术治疗往往降低颅内出血事件（OR = 0.25 [0.06-1.03]，P = .05）。关于DB/CB技术与IB技术，共分析了875名患者。两组患者发生缺血性中风（OR = 0.79 [0.31-1.97]，P = .61）、短暂性脑缺血发作（OR = 1.27[0.46-3.55]，P = .64）、新的或恶化的癫痫发作（OR = 1.05[0.3-3.65]，P = .93）、症状改善（OR = 2.45[0.71-8.45]，P = .16）和随访修正的 Rankin 量表≤2（OR = 1.21 [0.16-8.85]，P = .85）。相对于 IB，CB 与较高的松岛 A 级相关（OR = 3.44 [1.32-9.97]，P = .01）：结论：在这项荟萃分析中，与保守治疗相比，手术血管重建的临床疗效更佳。DB/CB与IB技术的临床效果相似。无论是通过 DB/CB 还是 IB 进行手术血流增强，似乎都能为有症状的 MMD 儿科患者带来益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.