{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T21:25:37Z","timestamp":1768685137356,"version":"3.49.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Moyamoya disease\/syndrome (MMD\/S) is a progressive, occlusive vasculopathy of the intracranial vasculature that leads to ischemic and hemorrhagic strokes. Significant debate exists regarding the role of indirect cerebrovascular bypass surgery in its management. The authors review their institution's experience with indirect bypass in the surgical management of patients with MMD\/S.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors conducted a retrospective review of patients with MMD\/S who underwent encephaloduroarteriosynangiosis (EDAS), a form of indirect bypass, from 1996 to 2013.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 37 patients (52 hemispheres) underwent an EDAS procedure for MMD\/S; 21 patients received revascularization of both hemispheres. Patients presented with the following: 49% with stroke, 35% with transient ischemic attack, 13% with hemorrhage, and 3% with seizure. The mean Suzuki grade was 3.46. The number of patients with a modified Rankin Scale score of 0\u20131 improved from 21 to 29 (p = 0.002) from the time of surgery to the time of last follow-up. The number of neurological events (i.e., transient ischemic attacks, strokes, and hemorrhages) decreased from a mean of 1.7 events per patient to 0.14 (p &lt; 0.001). The mean length of follow-up was 32.8 months.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This series demonstrates that EDAS is an effective procedure for MMD\/S in a North American cohort of patients.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.8.jns132176","type":"journal-article","created":{"date-parts":[[2014,10,3]],"date-time":"2014-10-03T15:46:19Z","timestamp":1412351179000},"page":"1394-1400","source":"Crossref","is-referenced-by-count":36,"title":["Surgical outcomes following encephaloduroarteriosynangiosis in North American adults with moyamoya"],"prefix":"10.3171","volume":"121","author":[{"given":"Pankaj K.","family":"Agarwalla","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher J.","family":"Stapleton","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael T.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian P.","family":"Walcott","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston;"},{"name":"Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Charlestown; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew S.","family":"Venteicher","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns132176","series-title":"Neurosurgery","first-page":"430","article-title":"Surgical outcomes for moyamoya angiopathy at Barrow Neurological Institute with comparison of adult indirect encephaloduroarteriosynangiosis bypass, adult direct superficial temporal artery-to-middle cerebral artery bypass, and pediatric bypass: 154 revascularization surgeries in 140 affected hemispheres","volume":"73","author":"Abla","year":"2013"},{"key":"b2-jns132176","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1136\/jnnp.2007.130666","article-title":"Novel epidemiological features of moyamoya disease","volume":"79","author":"Baba","year":"2008"},{"key":"b3-jns132176","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1227\/NEU.0b013e3182333c47","article-title":"Quantitative angiographic comparison with the OSIRIS program between the direct and indirect revascularization modalities in adult moyamoya disease","volume":"70","author":"Bang","year":"2012"},{"key":"b4-jns132176","series-title":"Clin Nucl Med","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/RLU.0b013e31827083d8","article-title":"Symptomatic cerebral hyperperfusion on SPECT after indirect revascularization surgery for Moyamoya disease","volume":"38","author":"Cho","year":"2013"},{"key":"b5-jns132176","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1007\/s00415-009-5424-8","article-title":"Neurocognitive dysfunction in adult moyamoya disease","volume":"257","author":"Festa","year":"2010"},{"key":"b6-jns132176","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1007\/s00701-012-1545-4","article-title":"Adult moyamoya after revascularization","volume":"155","author":"Gross","year":"2013"},{"key":"b7-jns132176","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.jocn.2012.08.002","article-title":"The natural history of moyamoya in a North American adult cohort","volume":"20","author":"Gross","year":"2013"},{"key":"b8-jns132176","series-title":"J Neurosurg","doi-asserted-by":"publisher","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":"Guzman","year":"2009"},{"key":"b9-jns132176","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1161\/01.STR.0000221787.70503.ca","article-title":"Clinical features and outcome in North American adults with moyamoya phenomenon","volume":"37","author":"Hallemeier","year":"2006"},{"key":"b10-jns132176","series-title":"J Neurol Neurosurg Psychiatry","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1136\/jnnp-2011-301387","article-title":"Regional differences in incidence and patient characteristics of moyamoya disease: a systematic review","volume":"83","author":"Kleinloog","year":"2012"},{"key":"b11-jns132176","series-title":"Eur J Neurol","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1111\/j.1468-1331.2011.03481.x","article-title":"What is the expert's option on antiplatelet therapy in moyamoya disease? Results of a worldwide Survey","volume":"19","author":"Kraemer","year":"2012"},{"key":"b12-jns132176","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1007\/s00701-012-1325-1","article-title":"Longterm follow-up results in 142 adult patients with moyamoya disease according to management modality","volume":"154","author":"Lee","year":"2012"},{"key":"b13-jns132176","series-title":"Clin Neurol Neurosurg","doi-asserted-by":"publisher","first-page":"1647","DOI":"10.1016\/j.clineuro.2013.02.018","article-title":"Coexistence of moyamoya and Graves' diseases: the clinical characteristics and treatment effects of 21 Chinese patients","volume":"115","author":"Li","year":"2013"},{"key":"b14-jns132176","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1016\/S0090-3019(81)80017-1","article-title":"A new surgical treatment of moyamoya disease in children: a preliminary report","volume":"15","author":"Matsushima","year":"1981"},{"key":"b15-jns132176","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/0090-3019(95)00475-0","article-title":"Indirect revascularization for moyamoya disease: is there a beneficial effect for adult patients?","volume":"45","author":"Mizoi","year":"1996"},{"key":"b16-jns132176","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"328","DOI":"10.3171\/2011.3.JNS101908","article-title":"Outcome of repeat revascularization surgery for moyamoya disease after an unsuccessful indirect revascularization. Clinical article","volume":"115","author":"Pandey","year":"2011"},{"key":"b17-jns132176","series-title":"World Neurosurg","article-title":"Risk profile in extracranial\/intracranial bypass surgery\u2014the role of antiplatelet agents, disease pathology, and surgical technique in 168 direct revascularization procedures","author":"Schubert","year":"2013"},{"key":"b18-jns132176","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1056\/NEJMra0804622","article-title":"Moyamoya disease and moyamoya syndrome","volume":"360","author":"Scott","year":"2009"},{"issue":"2 Suppl Pediatrics","key":"b19-jns132176","series-title":"J Neurosurg","first-page":"142","article-title":"Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis","volume":"100","author":"Scott","year":"2004"},{"key":"b20-jns132176","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1227\/NEU.0b013e318253ab8e","article-title":"Moyamoya disorder in the United States","volume":"71","author":"Starke","year":"2012"},{"key":"b21-jns132176","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"936","DOI":"10.3171\/2009.3.JNS08837","article-title":"Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease. Clinical article","volume":"111","author":"Starke","year":"2009"},{"key":"b22-jns132176","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1001\/archneur.1969.00480090076012","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki","year":"1969"},{"key":"b23-jns132176","series-title":"No To Shinkei","first-page":"37","article-title":"Hypogenesis of bilateral internal carotid arteries","volume":"9","author":"Takeuchi","year":"1957"},{"key":"b24-jns132176","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1212\/01.wnl.0000176066.33797.82","article-title":"Moyamoya disease in Washington State and California","volume":"65","author":"Uchino","year":"2005"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/121\/6\/article-p1394.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/121\/6\/article-p1394.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/121\/6\/article-p1394.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:29:01Z","timestamp":1658708941000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/121\/6\/article-p1394.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,12]]},"references-count":24,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2014.8.jns132176","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,12]]}}}