Journal Article

Surgical revascularizations for pediatric moyamoya: a systematic review, meta-analysis, and meta-regression analysis

James, Greg, Bhate, Sanjay, Silva, Adikarige Haritha Dulanka, Ganesan, Vijeya, Thompson, Dominic, Lee, Keng Siang, Zhang, John J. Y.

2023

Overview

Introduction There is no clear consensus regarding the technique of surgical revascularization for moyamoya disease and syndrome (MMD/MMS) in the pediatric population. Previous meta-analyses have attempted to address this gap in literature but with methodological limitations that affect the reliability of their pooled estimates. This meta-analysis aimed to report an accurate and transparent comparison between studies of indirect (IB), direct (DB), and combined bypasses (CB) in pediatric patients with MMD/MMS. Methods In accordance with PRISMA guidelines, systematic searches of Medline, Embase, and Cochrane Central were undertaken from database inception to 7 October 2022. Perioperative adverse events were the primary outcome measure. Secondary outcomes were rates of long-term revascularization, stroke recurrence, morbidity, and mortality. Results Thirty-seven studies reporting 2460 patients and 4432 hemispheres were included in the meta-analysis. The overall pooled mean age was 8.6 years (95% CI: 7.7; 9.5), and 45.0% were male. Pooled proportions of perioperative adverse events were similar between the DB/CB and IB groups except for wound complication which was higher in the former group (RR = 2.54 (95% CI: 1.82; 3.55)). Proportions of post-surgical Matsushima Grade A/B revascularization favored DB/CB over IB (RR = 1.12 (95% CI 1.02; 1.24)). There was no significant difference in stroke recurrence, morbidity, and mortality. After meta-regression analysis, year of publication and age were significant predictors of outcomes. Conclusions IB, DB/CB are relatively effective and safe revascularization options for pediatric MMD/MMS. Low-quality GRADE evidence suggests that DB/CB was associated with better long-term angiographic revascularization outcomes when compared with IB, although this did not translate to long-term stroke and mortality benefits.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Cerebral Revascularization - methods / Child / Female / Humans / Male / Medicine / Medicine & Public Health / Moyamoya Disease - complications / Moyamoya Disease - diagnostic imaging / Moyamoya Disease - surgery / Neurosciences / Neurosurgery / Reproducibility of Results / Review / Stroke - epidemiology / Stroke - etiology / Stroke - surgery / Treatment Outcome / Vascular Surgical Procedures