{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:30:57Z","timestamp":1772724657074,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>In adult patients with moyamoya disease (MMD), insufficient postoperative collateral formation is usually seen after combined bypass surgery. The arachnoid membrane, a critical anatomical barrier between extracranial and intracranial vascular systems, has an unclear role in postoperative angiogenesis. The aim of this study was to investigate whether intraoperative arachnoid membrane opening enhances angiogenesis in adult patients undergoing combined bypass surgery for MMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This multicenter, prospective, randomized controlled trial (Membrane Opening to Promote Angiogenesis in Adult MMD [MOPOAM]) was conducted across 8 institutions in China. Between June 2022 and August 2023, 104 patients diagnosed with MMD through digital subtraction angiography were randomly assigned to two groups: one group underwent arachnoid opening (n = 51), while the other group had arachnoid preservation (n = 53). The primary endpoint was the rate of good angiogenesis (Matsushima grade A and B) assessed 6\u201312 months postoperatively, and the secondary endpoint was the incidence of surgical complications within 1 month postsurgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>All 104 patients completed the study. The rate of good angiogenesis was 54.9% in the arachnoid opening group and 64.2% in the arachnoid preservation group, with no significant difference between groups (OR 1.470, 95% CI 0.669\u20133.229; p = 0.337). Postoperative complications were observed in 2 patients (3.9%) in the arachnoid opening group and in 5 patients (9.4%) in the arachnoid preservation group, showing no significant difference (OR 2.552, 95% CI, 0.472\u201313.796; p = 0.276). No significant association between arachnoid opening procedures and functional recovery (assessed by modified Rankin Scale scores) was found during the 6- to 12-month follow-up period (p = 0.831).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>In adults with MMD, arachnoid membrane opening during combined bypass surgery did not significantly improve postoperative angiogenesis rates or increase perioperative complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.5.jns25385","type":"journal-article","created":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:39:44Z","timestamp":1760146784000},"page":"462-471","source":"Crossref","is-referenced-by-count":0,"title":["Multiple arachnoid membrane opening to promote angiogenesis in adult patients with moyamoya disease after combined bypass surgery: a multicenter randomized controlled clinical trial"],"prefix":"10.3171","volume":"144","author":[{"given":"Songtao","family":"Qi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tinghan","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cerebrovascular Disease Hospital, Henan Provincial People\u2019s Hospital; Zhengzhou University, Zhengzhou City, Henan Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erming","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang City, Jiangxi Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengliang","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Guangdong Provincial People\u2019s Hospital, Guangdong Academy of Medical Sciences, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cong","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjian","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan City, Hubei Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ganzhou People\u2019s Hospital, Ganzhou City, Jiangxi Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guozhong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingzhou","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shichao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunyu","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huibin","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yabo","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Stroke Center, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenfeng","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"},{"name":"Laboratory for Precision Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou City, Guangdong Province;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"8","key":"b1","series-title":"Lancet Neurol","first-page":"747","article-title":"Moyamoya disease: diagnosis and interventions","volume":"21","author":"Ihara M","year":"2022","unstructured":"Ihara M, Yamamoto Y, Hattori Y,  Moyamoya disease: diagnosis and interventions. 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Neuroradiology. 1992;34(4):318\u2013322."},{"issue":"2","key":"b4","series-title":"Childs Nerv Syst","first-page":"237","article-title":"Hemorrhagic moyamoya disease in children: clinical features and surgical outcome","volume":"28","author":"Ahn JH","year":"2012","unstructured":"Ahn JH, Wang KC, Phi JH,  Hemorrhagic moyamoya disease in children: clinical features and surgical outcome. Childs Nerv Syst. 2012;28(2):237\u2013245."},{"issue":"3","key":"b5","series-title":"J Neurosurg","first-page":"612","article-title":"Treatment of moyamoya disease in the adult population with pial synangiosis","volume":"120","author":"Lin N","year":"2014","unstructured":"Lin N, Aronson JP, Manjila S, Smith ER, Scott RM. Treatment of moyamoya disease in the adult population with pial synangiosis. J Neurosurg. 2014;120(3):612\u2013617."},{"issue":"1","key":"b6","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. Stroke. 2016;47(1):240\u2013243."},{"issue":"6","key":"b7","series-title":"Neurosurgery","first-page":"950","article-title":"Long-term outcome after multiple burr hole surgery in children with moyamoya angiopathy: a single-center experience in 108 hemispheres","volume":"80","author":"Blauwblomme T","year":"2017","unstructured":"Blauwblomme T, Mathon B, Naggara O,  Long-term outcome after multiple burr hole surgery in children with moyamoya angiopathy: a single-center experience in 108 hemispheres. Neurosurgery. 2017;80(6):950\u2013956."},{"issue":"6","key":"b8","series-title":"J Neurosurg","first-page":"1898","article-title":"Encephaloduroarteriosynangiosis for hemorrhagic moyamoya disease: long-term outcome of a consecutive series of 95 adult patients from a single center","volume":"130","author":"Wang QN","year":"2019","unstructured":"Wang QN, Bao XY, Zhang Y, Zhang Q, Li DS, Duan L. Encephaloduroarteriosynangiosis for hemorrhagic moyamoya disease: long-term outcome of a consecutive series of 95 adult patients from a single center. J Neurosurg. 2019;130(6):1898\u20131905."},{"issue":"12","key":"b9","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1361","article-title":"Predictors of neoangiogenesis after indirect revascularisation in moyamoya disease: a 10-year follow-up study","volume":"92","author":"Wang QN","year":"2021","unstructured":"Wang QN, Yang RM, Zou ZX,  Predictors of neoangiogenesis after indirect revascularisation in moyamoya disease: a 10-year follow-up study. J Neurol Neurosurg Psychiatry. 2021;92(12):1361\u20131362."},{"issue":"12","key":"b10","series-title":"Acta Neurochir (Wien)","first-page":"3613","article-title":"How to reduce the complication rate of multiple burr holes surgery in moyamoya angiopathy","volume":"165","author":"Soler-Rico M","year":"2023","unstructured":"Soler-Rico M, Di Santo M, Vaz G,  How to reduce the complication rate of multiple burr holes surgery in moyamoya angiopathy. 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J Neurol Sci. 2024;461:123027."},{"issue":"1","key":"b24","series-title":"Emerg Med Int","first-page":"5059097","article-title":"Enhanced benefit of STA-MCA bypass surgery in chronic terminal internal carotid and\/or middle cerebral artery occlusion patients with impaired collateral circulation: introducing a novel assessment approach for collateral compensation","volume":"2025","author":"Qiu C","year":"2025","unstructured":"Qiu C, Zhang Y, Yu Z,  Enhanced benefit of STA-MCA bypass surgery in chronic terminal internal carotid and\/or middle cerebral artery occlusion patients with impaired collateral circulation: introducing a novel assessment approach for collateral compensation. 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Encephaloduroarteriosynangiosis for hemorrhagic moyamoya disease: long-term outcome of a consecutive series of 95 adult patients from a single center. J Neurosurg. 2019;130(6):1898\u20131905."},{"issue":"12","key":"b9","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1361","article-title":"Predictors of neoangiogenesis after indirect revascularisation in moyamoya disease: a 10-year follow-up study","volume":"92","author":"Wang QN","year":"2021","unstructured":"Wang QN, Yang RM, Zou ZX,  Predictors of neoangiogenesis after indirect revascularisation in moyamoya disease: a 10-year follow-up study. 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