The optimum operative time of revascularization for the patients with moyamoya disease following acute onset.

The optimum operative time of revascularization for the patients with moyamoya disease following acute onset.

World Neurosurg. 2018 Mar 09;:

Authors: Xu S, Zhang J, Wang S, Li Z, Xiong Z, Wu X, Xin C, Wang H, Wang Y, Chen J

Abstract
BACKGROUND: It is still controversial whether surgery should be performed on patients suffering from acute onset of moyamoya disease (MMD). The present study aims at determining an optimum operative time for the patients with MMD.
METHODS: We retrospectively analyzed 57 patients with MMD admitted between January 2016 and June 2017. All of them consented to combined revascularization. Considering the time interval between acute onset and surgery, we accordingly divided all patients into the early group and the later group if the latter exceeded 90 days. We compared the rate of postoperative complications, neurological improvement and favorable outcome between the two groups to estimate the optimum operative time of revascularization.
RESULTS: More patients in the early group presented with ischemic events compared to the later group (18/28 VS 11/29, P=0.047). But the difference in worst preoperative mRS (mRS ≥ 3) between the two groups was not significantly different (3/28 VS 3/29, P=0.964). The rate of postoperative complications in the early group was significantly higher than the later group (39.2% VS 13.7%, P=0.029). In the early group, 50.0% and 75.9% patients in the later group showed neurological improvement (P=0.043). The rate of favorable outcome after revascularization in the later group (89.7%) was higher than the early group (78.6%), but there was no significant difference (P = 0.251).
CONCLUSIONS: Our study suggests that it seems more reasonable to opt for delayed revascularization for patients with MMD after acute onset, but that must be balanced with the moribidity of ongoing ischemic or hemorrhagic events.

PMID: 29530705 [PubMed - as supplied by publisher]

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