P44 Direct and Combined Revascularization Versus Indirect Revascularization in the Treatment of Moyamoya Disease: A Systematic Review and Meta-Analysis

INTRODUCTION: There is currently no definite consensus regarding the surgical treatment of moyamoya disease (MMD). This study aimed to compare direct and combined versus indirect bypasses with regard to perioperative complications in pediatric and adult patients with MMD. METHODS: Systematic searches of Medline, Embase and Cochrane Central were undertaken. Primary outcome measures analyzed included perioperative complications defined as any major adverse events within 30 days after bypass surgery. RESULTS: 2490 studies were identified. 20 reporting 2982 patients were eventually included in our meta-analysis. Pooled mean age was 37.5 years (95%CI:33.5–41.5) and 7.4 years (95%CI:4.1–10.7) in adult and pediatric patients respectively. For adult patients, perioperative stroke rate was comparable between direct/combined bypass and indirect bypass (OR = 1.26 [95%CI:0.81–1.96], p = 0.300 for indirect bypass). For pediatric patients, perioperative stroke rate was comparable between direct/combined bypass and indirect bypass (OR = 2.43[95%CI:0.74–7.94], p = 0.143 for indirect bypass). No difference was found in perioperative mortality between direct/combined bypass and indirect bypass for adult patients (OR = 1.16[95%CI:0.07–19.00], p = 0.915 for indirect bypass). There was no difference in perioperative mortality between direct/combined bypass and indirect bypass (OR = 1.39 [95%CI:0 –Inf], p = 1.00 for indirect bypass) in pediatric patients. There was no significant difference in perioperative neurological deficit rates between direct/combined bypass and indirect bypass (OR = 1.27[95%CI:0.68–2.39], p = 0.451 for indirect bypass). DISCUSSIONS/CONCLUSIONS: Our meta-analysis provides statistical evidence suggesting that both direct and indirect bypasses can be equally effective in preventing stroke, with similar rates of perioperative complications in pediatric and adult patients.