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

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..

Medienart:	E-Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:39
Enthalten in:	Child's nervous system - 39(2023), 5 vom: 08. Feb., Seite 1225-1243

Sprache:	Englisch

Beteiligte Personen:	Lee, Keng Siang [VerfasserIn] Zhang, John J. Y. [VerfasserIn] Bhate, Sanjay [VerfasserIn] Ganesan, Vijeya [VerfasserIn] Thompson, Dominic [VerfasserIn] James, Greg [VerfasserIn] Silva, Adikarige Haritha Dulanka [VerfasserIn]

Links:	Volltext [kostenfrei]

Themen:	Bypass Moyamoya disease Moyamoya syndrome Neurosurgery Pediatric Revascularization

Anmerkungen:	© The Author(s) 2023

doi:	10.1007/s00381-023-05868-6

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PPN (Katalog-ID):	SPR052383059