{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:40:03Z","timestamp":1741048803362,"version":"3.38.0"},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Asian J Neurosurg"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003Moyamoya disease is a chronic, progressive, intracranial steno-occlusive disease. Cerebral revascularization has proved that it is more beneficial than medical therapy for prevention of recurrent stroke. We aimed to report clinical and surgical outcome of moyamoya disease after combined revascularization in Thai population.<\/jats:p><jats:p>\n          Materials and Methods\u2003From October 2015 to March 2023, patients diagnosed with moyamoya disease and were operated with combined revascularization were included. Patients were evaluated for hemodynamic state with preoperative and postoperative blood oxygenation level-dependent magnetic resonance (BOLD MR) imaging. Demographic data, serial imaging, surgical outcome, and clinical outcome were analyzed. Morbidity and mortality rates of surgery were reported. For clinical outcome evaluation, modified Rankin Scale (mRS) scores were compared between preoperative and postoperative outcome. The mRS score of 0 to 2 signify good outcome after surgery.<\/jats:p><jats:p>\n          Results\u2003There were a total of 55 patients. Ischemic stroke was the most common presentation (87.3%). Based on the Suzuki's classification, most of the patients were stage 3 and 4. Clinical outcome measured with mRS score had good outcome, 100% (mRS score 0\u20132). For surgical outcome, overall graft patency was 94.8%, overall complication rate was 6.5%, and mortality rate was zero. Mean follow-up duration was 44.5\u2009\u00b1\u200925.1 months. Recurrent stroke occurred in 1.3%, which was recurrent ischemic stroke.<\/jats:p><jats:p>\n          Conclusion\u2003Combined revascularization in moyamoya disease in the Thai population has a good clinical outcome, an acceptable risk of complication, and a reduced recurrent rate of stroke. Clinical and surgical outcome should be studied in the long term with the use of BOLD MR with carbon dioxide stimuli for the evaluation of cerebral blood flow in the patient.<\/jats:p>","DOI":"10.1055\/s-0044-1792159","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T00:38:28Z","timestamp":1732840708000},"page":"075-081","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcome and Surgical Outcome of Moyamoya Disease after Combined Revascularization Performed at the Neurological Institute of Thailand"],"prefix":"10.1055","volume":"20","author":[{"given":"Sarunya","family":"Yuthagovit","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute of Thailand, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Punjama","family":"Lertbutsayanuku","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wuttipong","family":"Tirakotai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute of Thailand, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,11,28]]},"reference":[{"volume-title":"Moyamoya Disease: Diagnosis and Treatment. 1st ed","author":"J KN Wanebo","key":"ref1"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"333","DOI":"10.2176\/nmc.52.333","article-title":"Surgical treatment of moyamoya disease in adults: combined direct and indirect vs. indirect bypass surgery","volume":"52","author":"D S Kim","year":"2012","journal-title":"Neurol Med Chir (Tokyo)"},{"issue":"05","key":"ref3","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.3171\/2014.7.JNS132434","article-title":"Outcome in adult patients with hemorrhagic moyamoya disease after combined extracranial-intracranial bypass","volume":"121","author":"H Jiang","year":"2014","journal-title":"J Neurosurg"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"1788","DOI":"10.3171\/2015.6.JNS151105","article-title":"Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia","volume":"124","author":"T Kim","year":"2016","journal-title":"J Neurosurg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.wneu.2016.10.117","article-title":"Surgical outcome for moyamoya disease: clinical and perfusion computed tomography correlation","volume":"98","author":"A H Cheung","year":"2017","journal-title":"World Neurosurg"},{"issue":"10","key":"ref6","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1161\/STROKEAHA.114.005624","article-title":"Long-term outcomes after combined revascularization surgery in adult moyamoya disease","volume":"45","author":"W S Cho","year":"2014","journal-title":"Stroke"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"927","DOI":"10.3171\/2009.4.JNS081649","article-title":"Clinical outcome after 450 revascularization procedures for moyamoya disease. Clinical article","volume":"111","author":"R Guzman","year":"2009","journal-title":"J Neurosurg"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3171\/2014.10.JNS132369","article-title":"Clinical features and long-term outcomes of moyamoya disease: a single-center experience with 528 cases in China","volume":"122","author":"X J Liu","year":"2015","journal-title":"J Neurosurg"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.3171\/2016.12.JNS162626","article-title":"Effects of different surgical modalities on the clinical outcome of patients with moyamoya disease: a prospective cohort study","volume":"128","author":"X Deng","year":"2018","journal-title":"J Neurosurg"},{"issue":"08","key":"ref10","doi-asserted-by":"crossref","first-page":"104846","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104846","article-title":"Postoperative functional outcomes and prognostic factors in two types of adult moyamoya diseases","volume":"29","author":"M Zhang","year":"2020","journal-title":"J Stroke Cerebrovasc Dis"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1227\/00006123-199209000-00003","article-title":"Surgical treatment of moyamoya disease in pediatric patients\u2013comparison between the results of indirect and direct revascularization procedures","volume":"31","author":"T Matsushima","year":"1992","journal-title":"Neurosurgery"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s10143-016-0734-7","article-title":"Long-term follow-up of pediatric moyamoya disease treated by combined direct-indirect revascularization surgery: single institute experience with surgical and perioperative management","volume":"39","author":"S Rashad","year":"2016","journal-title":"Neurosurg Rev"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3389\/fneur.2019.00014","article-title":"Clinical features, surgical treatment, and long-term outcome of a multicenter cohort of pediatric moyamoya","volume":"10","author":"J Zheng","year":"2019","journal-title":"Front Neurol"},{"issue":"S 02","key":"ref14","doi-asserted-by":"crossref","first-page":"S238","DOI":"10.1016\/S0303-8467(97)00082-6","article-title":"Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (\u2018moyamoya\u2019 disease). Research Committee on Spontaneous Occlusion of the Circle of Willis (Moyamoya Disease) of the Ministry of Health and Welfare, Japan","volume":"99","author":"M Fukui","year":"1997","journal-title":"Clin Neurol Neurosurg"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"848","DOI":"10.3171\/2014.10.JNS141140","article-title":"Clinical features and disease progression in moyamoya disease patients with Graves disease","volume":"123","author":"J-B Chen","year":"2015","journal-title":"J Neurosurg"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1507\/endocrj.EJ22-0319","article-title":"Clinical features of moyamoya disease with Graves' disease: a retrospective study of 394,422 patients with thyroid disease","volume":"70","author":"M Hiruma","year":"2023","journal-title":"Endocr J"},{"issue":"02","key":"ref17","first-page":"171","article-title":"Effect of surgery on the long-term functional outcome of moyamoya disease: a meta-analysis","volume":"29","author":"Z Yao","year":"2019","journal-title":"Turk Neurosurg"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"1100901","DOI":"10.3389\/fsurg.2023.1100901","article-title":"Superficial temporal artery-middle cerebral artery bypass in combination with encephalo-myo-synangiosis in Chinese adult patients with moyamoya disease","volume":"10","author":"L Li","year":"2023","journal-title":"Front Surg"},{"issue":"08","key":"ref19","doi-asserted-by":"crossref","first-page":"578","DOI":"10.7150\/ijms.15390","article-title":"Progress on complications of direct bypass for moyamoya disease","volume":"13","author":"J Yu","year":"2016","journal-title":"Int J Med Sci"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1161\/STROKEAHA.117.018563","article-title":"Surgical management of moyamoya disease","volume":"49","author":"G Acker","year":"2018","journal-title":"Stroke"},{"issue":"05","key":"ref21","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/j.wneu.2013.06.010","article-title":"Risk profile in extracranial\/intracranial bypass surgery\u2013the role of antiplatelet agents, disease pathology, and surgical technique in 168 direct revascularization procedures","volume":"82","author":"G A Schubert","year":"2014","journal-title":"World Neurosurg"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"e446","DOI":"10.1016\/j.wneu.2022.06.067","article-title":"Outcomes of combined revascularization surgery for moyamoya disease without preoperative cerebral angiography","volume":"165","author":"T Okuyama","year":"2022","journal-title":"World Neurosurg"},{"issue":"02","key":"ref23","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3171\/2014.1.JNS13946","article-title":"The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review","volume":"121","author":"K Kazumata","year":"2014","journal-title":"J Neurosurg"},{"issue":"24","key":"ref24","first-page":"4398","article-title":"Superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis in treating moyamoya disease: surgical techniques, indications and midterm follow-up results","volume":"125","author":"B Xu","year":"2012","journal-title":"Chin Med J (Engl)"},{"issue":"05","key":"ref25","doi-asserted-by":"crossref","first-page":"327","DOI":"10.2176\/nmc.52.327","article-title":"Lessons learned from moyamoya disease: outcome of direct\/indirect revascularization surgery for 150 affected hemispheres","volume":"52","author":"M Fujimura","year":"2012","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"101713","DOI":"10.1016\/j.nicl.2019.101713","article-title":"Hypercapnic BOLD MRI compared to H2\n          15O PET\/CT for the hemodynamic evaluation of patients with moyamoya disease","volume":"22","author":"T K Hauser","year":"2019","journal-title":"Neuroimage Clin"},{"issue":"03","key":"ref27","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1159\/000513301","article-title":"Longitudinal reproducibility of CO2-triggered BOLD MRI for the hemodynamic evaluation of adult patients with moyamoya angiopathy","volume":"50","author":"C Roder","year":"2021","journal-title":"Cerebrovasc Dis"}],"container-title":["Asian Journal of Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1792159.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T23:58:14Z","timestamp":1741046294000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1792159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,28]]},"references-count":27,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2025,3,3]]},"published-print":{"date-parts":[[2025,3]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1792159","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1793-5482","2248-9614"],"issn-type":[{"type":"print","value":"1793-5482"},{"type":"electronic","value":"2248-9614"}],"subject":[],"published":{"date-parts":[[2024,11,28]]}}}