{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:13:27Z","timestamp":1790417607519,"version":"4.1.0"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","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>The post-bypass stroke risk factors and long-term outcomes of moyamoya patients are not well documented. Therefore, the authors studied 30-day stroke risks and patients\u2019 long-term physical, functional, and social well-being.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This was a single-institution combined moyamoya disease (MMD) database interrogation and questionnaire study. From 1991 to 2014, 1250 revascularization procedures (1118 direct bypasses, 132 indirect bypasses) were performed in 769 patients. Completed questionnaires were received from and available for analysis on 391 patients, and 6-month follow-up data were available for 96.4% (741\/769) of the patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The patients consisted of 548 females and 221 males, with a mean age of 32 years (range 1\u201369 years). Three hundred fifty-eight bypasses were performed in 205 pediatric patients (73% direct bypasses), and 892 revascularizations were performed in 564 adults (96% direct bypasses). Fifty-two patients (6.8%) developed major strokes with a worsening modified Rankin Scale (mRS) score within 30 days postoperatively. The 30-day major stroke risk was 5.3% (41\/769) and 2.6% (12\/467) after the first and second bypasses, respectively. Logistic regression analysis revealed that older age, modified MRI (mMRI) score, and hemodynamic reserve (HDR) score are clearly associated with higher postoperative stroke risks. Over a mean follow-up of 7.3 years (range 0.5\u201326 years), the long-term stroke risk among 741 patients was 0.6% per patient-year; 75% of these patients had excellent outcomes (mRS score 0\u20131). The long-term outcome questionnaire study showed that 84% (234\/277) of patients reported resolution or improvement in their preoperative headache, 83% (325\/391) remained employed or in school, and 87% (303\/348) were self-caring.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In this large, single-center surgical series, most of the adult and pediatric patients had direct revascularization, with a 4.2% per-bypass-procedure (6.8% per patient) 30-day major stroke risk and a 0.6% per-patient-year long-term stroke risk. The authors identified various risk factors that are highly correlated with postoperative morbidity (age, mMRI score, and HDR score) and are involved in ongoing work to develop the predictive modeling for future patient selection and treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.8.jns22336","type":"journal-article","created":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T12:38:01Z","timestamp":1666355881000},"page":"1374-1384","source":"Crossref","is-referenced-by-count":26,"title":["Short- and long-term outcomes of moyamoya patients post-revascularization"],"prefix":"10.3171","volume":"138","author":[{"given":"Mario","family":"Teo","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Abhinav","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa E.","family":"Bell-Stephens","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venkatesh S.","family":"Madhugiri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Sussman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tej Deepak","family":"Azad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohaid","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rogelio","family":"Esparza","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary K.","family":"Steinberg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine and Stanford Stroke Center, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Cerebrovasc Dis","first-page":"305","article-title":"Clinical features, surgical treatment and long-term outcome in adult patients with Moyamoya disease in China","volume":"34","author":"Bao XY","year":"2012","unstructured":"Bao XY, Duan L, Li DS,  Clinical features, surgical treatment and long-term outcome in adult patients with Moyamoya disease in China. Cerebrovasc Dis. 2012;34(4):305\u2013313."},{"issue":"10","key":"b2","series-title":"Stroke","first-page":"3025","article-title":"Long-term outcomes after combined revascularization surgery in adult moyamoya disease","volume":"45","author":"Cho WS","year":"2014","unstructured":"Cho WS, Kim JE, Kim CH,  Long-term outcomes after combined revascularization surgery in adult moyamoya disease. Stroke. 2014;45(10):3025\u20133031."},{"issue":"3","key":"b3","series-title":"Acta Neurochir (Wien)","first-page":"551","article-title":"Incidence of late cerebrovascular events after direct bypass among children with moyamoya disease: a descriptive longitudinal study at a single center","volume":"156","author":"Funaki T","year":"2014","unstructured":"Funaki T, Takahashi JC, Takagi Y,  Incidence of late cerebrovascular events after direct bypass among children with moyamoya disease: a descriptive longitudinal study at a single center. Acta Neurochir (Wien). 2014;156(3):551\u2013559."},{"issue":"1","key":"b4","series-title":"Stroke","first-page":"240","article-title":"Hemorrhagic moyamoya disease in children: clinical, angiographic features, and long-term surgical outcome","volume":"47","author":"Liu P","year":"2016","unstructured":"Liu P, Han C, Li DS, Lv XL, Li YX, Duan L. Hemorrhagic moyamoya disease in children: clinical, angiographic features, and long-term surgical outcome. 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J Neurosurg. 2020;134(5):1578\u20131589."},{"issue":"3","key":"b30","series-title":"Surg Neurol","first-page":"273","article-title":"Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease","volume":"67","author":"Fujimura M","year":"2007","unstructured":"Fujimura M, Kaneta T, Mugikura S, Shimizu H, Tominaga T. Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. 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Surg Neurol. 2009;71(4):442\u2013447."},{"issue":"6","key":"b32","series-title":"Cerebrovasc Dis","first-page":"580","article-title":"Transient hyperperfusion after superficial temporal artery\/middle cerebral artery bypass surgery as a possible cause of postoperative transient neurological deterioration","volume":"25","author":"Kim JE","year":"2008","unstructured":"Kim JE, Oh CW, Kwon OK, Park SQ, Kim SE, Kim YK. Transient hyperperfusion after superficial temporal artery\/middle cerebral artery bypass surgery as a possible cause of postoperative transient neurological deterioration. Cerebrovasc Dis. 2008;25(6):580\u2013586."},{"issue":"1","key":"b33","series-title":"J Neurosurg","first-page":"90","article-title":"Is local hypoperfusion the reason for transient neurological deficits after STA-MCA bypass for moyamoya disease?","volume":"122","author":"Mukerji N","year":"2015","unstructured":"Mukerji N, Cook DJ, Steinberg GK. Is local hypoperfusion the reason for transient neurological deficits after STA-MCA bypass for moyamoya disease? J Neurosurg. 2015;122(1):90\u201394."},{"issue":"6","key":"b34","series-title":"Stroke","first-page":"1490","article-title":"Clinical features and outcome in North American adults with moyamoya phenomenon","volume":"37","author":"Hallemeier CL","year":"2006","unstructured":"Hallemeier CL, Rich KM, Grubb RL Jr,  Clinical features and outcome in North American adults with moyamoya phenomenon. Stroke. 2006;37(6):1490\u20131496."},{"issue":"11","key":"b35","series-title":"Stroke","first-page":"2272","article-title":"Clinical course, surgical management, and long-term outcome of moyamoya patients with rebleeding after an episode of intracerebral hemorrhage: an extensive follow-up study","volume":"30","author":"Yoshida Y","year":"1999","unstructured":"Yoshida Y, Yoshimoto T, Shirane R, Sakurai Y. Clinical course, surgical management, and long-term outcome of moyamoya patients with rebleeding after an episode of intracerebral hemorrhage: an extensive follow-up study. Stroke. 1999;30(11):2272\u20132276."},{"issue":"5","key":"b36","series-title":"Stroke","first-page":"1415","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial","volume":"45","author":"Miyamoto S","year":"2014","unstructured":"Miyamoto S, Yoshimoto T, Hashimoto N,  Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. 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