{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:49:39Z","timestamp":1789469379280,"version":"build-2803163510"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Side-to-side (S-S) superficial temporal artery\u2013middle cerebral artery (STA-MCA) bypass was reportedly used to treat a special moyamoya disease (MMD) patient with collaterals arising from the donor STA. However, the S-S technique is not routinely performed to date, and its benefits are still unknown for adult MMD. The purpose of this study was to investigate the possibility of routine use of the S-S technique for adult MMD.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors retrospectively analyzed the clinical data of 50 adult patients (65 hemispheres, including 30 in the end-to-side [E-S] group and 35 in the S-S group) with MMD who underwent STA-MCA bypass. The patient demographic characteristics, clinical courses, technical details, intraoperative blood flow data, postoperative and preoperative relative cerebral blood flow (rCBF) values, modified Rankin Scale (mRS) scores, and short-term revascularization results were compared between the 2 groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>There were no significant differences observed in terms of the baseline characteristics, bypass patency rates, postoperative\/preoperative rCBF values, incidence of cerebral hyperperfusion syndrome (CHS), mRS scores, and short-term revascularization results between the 2 groups (all p &gt; 0.05). Intraoperative blood flow analysis showed that the increase of STA flow in the E-S group was significantly higher than that of proximal STA flow in the S-S group (p = 0.008). Although the increases of proximal and distal recipient flow in the E-S group seemed greater than those in the S-S group, the results were not statistically significant (p = 0.086 for proximal flow and p = 0.076 for distal flow). CHS symptoms in the S-S group were milder and with much shorter duration. The follow-up angiographic data of the representative case demonstrated that both frontal and parietal STA branches and the occipital artery participated in postoperative collateralization.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>S-S anastomosis can achieve comparable clinical effects to standard E-S construction. S-S anastomosis used in adult MMD demonstrated mild CHS symptoms with short duration and had the potential to arouse all scalp arteries as donor sources for revascularization through the intact distal STA branch via flow self-regulation.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.8.jns221379","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T11:57:44Z","timestamp":1665143864000},"page":"1347-1356","source":"Crossref","is-referenced-by-count":21,"title":["A flow self-regulating superficial temporal artery\u2013middle cerebral artery bypass based on side-to-side anastomosis for adult patients with moyamoya disease"],"prefix":"10.3171","volume":"138","author":[{"given":"Jianjian","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"Xin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miki","family":"Fujimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsz Yeung","family":"Lau","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miao","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingrui","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianshu","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changyin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"},{"name":"Medical Research Institute, Wuhan University, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jincao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Lancet Neurol","first-page":"1056","article-title":"Moyamoya disease: current concepts and future perspectives","volume":"7","author":"Kuroda S","year":"2008","unstructured":"Kuroda S, Houkin K. Moyamoya disease: current concepts and future perspectives. Lancet Neurol. 2008;7(11):1056\u20131066."},{"key":"b2","series-title":"World Neurosurg","first-page":"357","article-title":"Cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease: systematic review and meta-analysis","volume":"135","author":"Yu J","year":"2020","unstructured":"Yu J, Zhang J, Li J, Zhang J, Chen J. Cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease: systematic review and meta-analysis. World Neurosurg. 2020;135:357\u2013366.e4."},{"issue":"10","key":"b3","series-title":"Stroke","first-page":"2610","article-title":"Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease: a serial single photon emission CT\/positron emission tomography study","volume":"43","author":"Uchino H","year":"2012","unstructured":"Uchino H, Kuroda S, Hirata K, Shiga T, Houkin K, Tamaki N. Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease: a serial single photon emission CT\/positron emission tomography study. Stroke. 2012;43(10):2610\u20132616."},{"issue":"5","key":"b4","series-title":"Oper Neurosurg (Hagerstown)","first-page":"480","article-title":"Side-to-side superficial temporal artery to middle cerebral artery bypass technique: application of fourth generation bypass in a case of adult moyamoya disease","volume":"18","author":"Lang MJ","year":"2020","unstructured":"Lang MJ, Kan P, Baranoski JF, Lawton MT. Side-to-side superficial temporal artery to middle cerebral artery bypass technique: application of fourth generation bypass in a case of adult moyamoya disease. Oper Neurosurg (Hagerstown). 2020;18(5):480\u2013486."},{"issue":"4","key":"b5","series-title":"Neurol Med Chir (Tokyo)","first-page":"165","article-title":"2021 Japanese Guidelines for the Management of Moyamoya Disease: Guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society","volume":"62","author":"Fujimura M","year":"2022","unstructured":"Fujimura M, Tominaga T, Kuroda S,  2021 Japanese Guidelines for the Management of Moyamoya Disease: Guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society. Neurol Med Chir (Tokyo). 2022;62(4):165\u2013170."},{"issue":"5","key":"b6","series-title":"Neurol Med Chir (Tokyo)","first-page":"245","article-title":"Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis)","volume":"52","author":"Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis","year":"2012","unstructured":"Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis. Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis). Neurol Med Chir (Tokyo). 2012;52(5):245\u2013266."},{"issue":"7","key":"b7","series-title":"Neurol Med Chir (Tokyo)","first-page":"307","article-title":"Diagnostic criteria for moyamoya disease - 2021 revised version","volume":"62","author":"Kuroda S","year":"2022","unstructured":"Kuroda S, Fujimura M, Takahashi J,  Diagnostic criteria for moyamoya disease - 2021 revised version. Neurol Med Chir (Tokyo). 2022;62(7):307\u2013312."},{"issue":"1","key":"b8","series-title":"J Neurosurg","first-page":"17","article-title":"Hemodynamic analysis of the recipient parasylvian cortical arteries for predicting postoperative hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease","volume":"134","author":"Zhang J","year":"2019","unstructured":"Zhang J, Li S, Fujimura M,  Hemodynamic analysis of the recipient parasylvian cortical arteries for predicting postoperative hyperperfusion during STA-MCA bypass in adult patients with moyamoya disease. J Neurosurg. 2019;134(1):17\u201324."},{"issue":"4","key":"b9","series-title":"Cerebrovasc Dis","first-page":"361","article-title":"Matching selection of donor-recipient vessels in revascularization surgery effectively reduce the incidence of postoperative hyperperfusion syndrome in adult moyamoya disease: a retrospective comparison study","volume":"49","author":"Zeng X","year":"2020","unstructured":"Zeng X, Su K, Tian X, Chen J. Matching selection of donor-recipient vessels in revascularization surgery effectively reduce the incidence of postoperative hyperperfusion syndrome in adult moyamoya disease: a retrospective comparison study. Cerebrovasc Dis. 2020;49(4):361\u2013368."},{"issue":"2","key":"b10","series-title":"Neurol Res","first-page":"131","article-title":"Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease","volume":"37","author":"Fujimura M","year":"2015","unstructured":"Fujimura M, Niizuma K, Endo H,  Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease. Neurol Res. 2015;37(2):131\u2013138."},{"issue":"4","key":"b11","series-title":"Neurosurgery","first-page":"957","article-title":"Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography","volume":"68","author":"Fujimura M","year":"2011","unstructured":"Fujimura M, Shimizu H, Inoue T, Mugikura S, Saito A, Tominaga T. Significance of focal cerebral hyperperfusion as a cause of transient neurologic deterioration after extracranial-intracranial bypass for moyamoya disease: comparative study with non-moyamoya patients using N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography. Neurosurgery. 2011;68(4):957\u2013965."},{"issue":"3","key":"b12","series-title":"Neurosurgery","first-page":"401","article-title":"Surgical treatment of moyamoya disease in pediatric patients\u2014comparison between the results of indirect and direct revascularization procedures","volume":"31","author":"Matsushima T","year":"1992","unstructured":"Matsushima T, Inoue T, Suzuki SO, Fujii K, Fukui M, Hasuo K. Surgical treatment of moyamoya disease in pediatric patients\u2014comparison between the results of indirect and direct revascularization procedures. Neurosurgery. 1992;31(3):401\u2013405."},{"issue":"1","key":"b13","series-title":"Neurocirugia (Astur)","first-page":"5","article-title":"Bypass surgery for the prevention of ischemic stroke: current indications and techniques","volume":"23","author":"Rodr\u00edguez-Hern\u00e1ndez A","year":"2012","unstructured":"Rodr\u00edguez-Hern\u00e1ndez A, Josephson SA, Lawton MT. Bypass surgery for the prevention of ischemic stroke: current indications and techniques. Neurocirugia (Astur). 2012;23(1):5\u201314."},{"issue":"1","key":"b14","series-title":"J Neurosurg","first-page":"80","article-title":"Long-term patency in cerebral revascularization surgery: an analysis of a consecutive series of 430 bypasses","volume":"131","author":"Yoon S","year":"2018","unstructured":"Yoon S, Burkhardt JK, Lawton MT. Long-term patency in cerebral revascularization surgery: an analysis of a consecutive series of 430 bypasses. J Neurosurg. 2018;131(1):80\u201387."},{"issue":"4","key":"b15","series-title":"Oper Neurosurg (Hagerstown)","first-page":"365","article-title":"Single vessel double anastomosis for flow augmentation - a novel technique for direct extracranial to intracranial bypass surgery","volume":"17","author":"Arnone GD","year":"2019","unstructured":"Arnone GD, Hage ZA, Charbel FT. Single vessel double anastomosis for flow augmentation - a novel technique for direct extracranial to intracranial bypass surgery. Oper Neurosurg (Hagerstown). 2019;17(4):365\u2013375."},{"key":"b16","series-title":"Ther Adv Neurol Disord","first-page":"1756286419878343","article-title":"Paradoxical association of symptomatic cerebral edema with local hypoperfusion caused by the \u2018watershed shift\u2019 after revascularization surgery for adult moyamoya disease: a case report","volume":"12","author":"Yu J","year":"2019","unstructured":"Yu J, Hu M, Yi L, Zhou K, Zhang J, Chen J. Paradoxical association of symptomatic cerebral edema with local hypoperfusion caused by the \u2018watershed shift\u2019 after revascularization surgery for adult moyamoya disease: a case report. Ther Adv Neurol Disord. 2019;12:1756286419878343."},{"issue":"3","key":"b17","series-title":"Neurosurg Rev","first-page":"507","article-title":"Uneven cerebral hemodynamic change as a cause of neurological deterioration in the acute stage after direct revascularization for moyamoya disease: cerebral hyperperfusion and remote ischemia caused by the \u2018watershed shift\u2019","volume":"40","author":"Tu XK","year":"2017","unstructured":"Tu XK, Fujimura M, Rashad S,  Uneven cerebral hemodynamic change as a cause of neurological deterioration in the acute stage after direct revascularization for moyamoya disease: cerebral hyperperfusion and remote ischemia caused by the \u2018watershed shift\u2019. Neurosurg Rev. 2017;40(3):507\u2013512."},{"issue":"3-6","key":"b18","series-title":"Cerebrovasc Dis","first-page":"217","article-title":"Significance of quantitative cerebral blood flow measurement in the acute stage after revascularization surgery for adult moyamoya disease: implication for the pathological threshold of local cerebral hyperperfusion","volume":"48","author":"Kameyama M","year":"2019","unstructured":"Kameyama M, Fujimura M, Tashiro R,  Significance of quantitative cerebral blood flow measurement in the acute stage after revascularization surgery for adult moyamoya disease: implication for the pathological threshold of local cerebral hyperperfusion. Cerebrovasc Dis. 2019;48(3-6):217\u2013225."},{"issue":"7","key":"b19","series-title":"Stroke","first-page":"1930","article-title":"Edaravone reduces hyperperfusion-related neurological deficits in adult moyamoya disease: historical control study","volume":"47","author":"Uchino H","year":"2016","unstructured":"Uchino H, Nakayama N, Kazumata K, Kuroda S, Houkin K. Edaravone reduces hyperperfusion-related neurological deficits in adult moyamoya disease: historical control study. Stroke. 2016;47(7):1930\u20131932."},{"issue":"8","key":"b20","series-title":"Int J Med Sci","first-page":"578","article-title":"Progress on complications of direct bypass for moyamoya disease","volume":"13","author":"Yu J","year":"2016","unstructured":"Yu J, Shi L, Guo Y, Xu B, Xu K. Progress on complications of direct bypass for moyamoya disease. Int J Med Sci. 2016;13(8):578\u2013587."},{"issue":"12","key":"b21","series-title":"Acta Neurochir (Wien)","first-page":"2409","article-title":"Clinical presentation, progression, and treatment outcomes of moyamoya disease in the elderly","volume":"158","author":"Gupta R","year":"2016","unstructured":"Gupta R, M Moore J, Adeeb N,  Clinical presentation, progression, and treatment outcomes of moyamoya disease in the elderly. Acta Neurochir (Wien). 2016;158(12):2409\u20132414."},{"issue":"9","key":"b22","series-title":"J Clin Med","first-page":"1898","article-title":"Patients with moyamoya vasculopathy evaluated at a single-center in the Netherlands; clinical presentation and outcome","volume":"10","author":"Kronenburg A","year":"2021","unstructured":"Kronenburg A, Kleinloog R, van der Zwan A,  Patients with moyamoya vasculopathy evaluated at a single-center in the Netherlands; clinical presentation and outcome. J Clin Med. 2021;10(9):1898."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/138\/5\/article-p1347.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/138\/5\/article-p1347.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/138\/5\/article-p1347.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T13:16:29Z","timestamp":1732194989000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/138\/5\/article-p1347.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,1]]},"references-count":22,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2022.8.jns221379","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,1]]}}}