{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:49:40Z","timestamp":1789469380431,"version":"build-2803163510"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:00:00Z","timestamp":1755216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82201481"],"award-info":[{"award-number":["82201481"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82271363"],"award-info":[{"award-number":["82271363"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Superficial temporal artery-middle cerebral artery (STA-MCA) bypass, characterized by side-to-side (S-S) anastomosis, has been beneficial in reducing the incidence of postoperative complications and recurrent stroke in patients with moyamoya disease (MMD). However, the safety and efficacy of this unconventional S-S procedure remain unclear. This research aimed to investigate the clinical and hemodynamic outcomes associated with the S-S technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical and radiographic data were collected from 50 adult patients with MMD (50 hemispheres), including 23 cases treated with S-S anastomosis and 27 cases treated with end-to-side (E-S) STA-MCA bypass. The patients\u2019 demographic information, clinical presentation, associated medical conditions, intraoperative hemodynamics, postoperative hemispheric perfusion status, and clinical course were obtained through a review of medical records, intraoperative microvascular Doppler ultrasonography (MDU), and postoperative CT perfusion (CTP) imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was no significant difference between the S-S and E-S groups in baseline characteristics, postoperative complications, bypass patency rate, neovascularization, and modified Rankin Scale (mRS) scores (<jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05). However, significant differences were noted in bypass time and anastomosis size between the E-S and S-S groups (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001). Intraoperative MDU analysis demonstrated that the mean velocity value (MVV) of the recipient artery entering the Sylvian fissure (RA.ES) and the MVV fold change in donor vessels were significantly higher in the S-S group compared to the E-S group (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Postoperative CTP analysis showed no difference in the volume of the infarct core, hypoperfusion, and penumbra between the groups (<jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The S-S technique demonstrated a different intraoperative self-flow regulation capacity compared to the traditional E-S technique, but it showed no superiority in postoperative hemispheric perfusion and clinical outcomes. The choice of bypass procedure should be individualized.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1632626","type":"journal-article","created":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T11:01:03Z","timestamp":1755255663000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Clinical and hemodynamic outcomes of side-to-side anastomosis in superficial temporal artery-middle cerebral artery bypass for adult patients with moyamoya disease: a prospective cohort study"],"prefix":"10.3389","volume":"16","author":[{"given":"Zhiyong","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongren","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinhua","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyun","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunhua","family":"Hang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongbo","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1227\/NEU.0000000000001850","article-title":"Revascularization of hemorrhagic moyamoya disease in a North American cohort: the role of timing in perioperative and long-term outcomes","volume":"90","author":"Xu","year":"2022","journal-title":"Neurosurgery"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3572","DOI":"10.1161\/STROKEAHA.122.039584","article-title":"Direct, indirect, and combined extracranial-to-intracranial bypass for adult moyamoya disease: an updated systematic review and meta-analysis","volume":"53","author":"Nguyen","year":"2022","journal-title":"Stroke"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1093\/ons\/opz268","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","year":"2020","journal-title":"Oper Neurosurg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.3171\/2022.8.JNS221379","article-title":"A flow self-regulating superficial temporal artery-middle cerebral artery bypass based on side-to-side anastomosis for adult patients with moyamoya disease","volume":"138","author":"Zhang","year":"2022","journal-title":"J Neurosurg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"245","DOI":"10.2176\/nmc.52.245","article-title":"Guidelines for diagnosis and treatment of moyamoya disease (spontaneous occlusion of the circle of Willis)","volume":"52","year":"2012","journal-title":"Neurol Med Chir"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1136\/svn-2019-000317","article-title":"Haemodynamic analysis of adult patients with moyamoya disease: CT perfusion and DSA gradings","volume":"6","author":"Shi","year":"2021","journal-title":"Stroke Vasc Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/RMR.0000000000000122","article-title":"ASPECTS CT in acute ischemia: review of current data","volume":"26","author":"Prakkamakul","year":"2017","journal-title":"Top Magn Reson Imaging"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12883-021-02511-2","article-title":"Predictors of preoperative cognitive dysfunction in adults with moyamoya disease: a preliminary research","volume":"22","author":"Sun","year":"2022","journal-title":"BMC Neurol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"104811","DOI":"10.1016\/j.jstrokecerebrovasdis.2020.104811","article-title":"Combined STA-MCA bypass and encephalodurosynangiosis versus encephalodurosynangiosis alone in adult hemorrhagic moyamoya disease: a 5-year outcome study","volume":"29","author":"Zhang","year":"2020","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"3855","DOI":"10.3390\/jcm12113855","article-title":"Intraoperative hemodynamics of Parasylvian cortical arteries for predicting postoperative symptomatic cerebral hyperperfusion after direct revascularization in patients with moyamoya disease: a preliminary study","volume":"12","author":"Shi","year":"2023","journal-title":"J Clin Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1159\/000520801","article-title":"Transient global cerebral hypoperfusion as a characteristic cerebral hemodynamic pattern in the acute stage after combined revascularization surgery for pediatric moyamoya disease: N-isopropyl-P-[123I] iodoamphetamine single-photon emission computed tomography study","volume":"51","author":"Kanoke","year":"2022","journal-title":"Cerebrovasc Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1179\/1743132814Y.0000000432","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","year":"2015","journal-title":"Neurol Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"627","DOI":"10.3171\/2021.2.JNS204333","article-title":"One-donor, two-recipient extracranial-intracranial bypass series for moyamoya and cerebral occlusive disease: rationale, clinical and angiographic outcomes, and intraoperative blood flow analysis","volume":"136","author":"Khan","year":"2022","journal-title":"J Neurosurg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"V16","DOI":"10.3171\/2021.10.FOCVID21191","article-title":"Application of FLOW 800 in extracranial-to-intracranial bypass surgery for moyamoya disease","volume":"6","author":"Yim","year":"2022","journal-title":"Neurosurgical Focus: Video"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"976695","DOI":"10.3389\/fneur.2022.976695","article-title":"Clinical use of color Doppler ultrasonography to predict and evaluate the collateral development of two common revascularizations in patients with moyamoya disease","volume":"13","author":"Wang","year":"2022","journal-title":"Front Neurol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"519","DOI":"10.4103\/1793-5482.153497","article-title":"Efficacy of superficial temporal artery-middle cerebral artery bypass in cerebrovascular steno-occlusive diseases: hemodynamics assessed by perfusion computed tomography","volume":"12","author":"Kwon","year":"2017","journal-title":"Asian J Neurosurg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e19168","DOI":"10.1097\/MD.0000000000019168","article-title":"Quantitative analysis of revascularization in ischemic moyamoya disease via whole-brain computed tomography perfusion: a retrospective single-center study","volume":"99","author":"Han","year":"2020","journal-title":"Medicine"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1159\/000504835","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","year":"2019","journal-title":"Cerebrovasc Dis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.3389\/fneur.2018.01121","article-title":"Direct bypass surgery vs. combined bypass surgery for hemorrhagic moyamoya disease: a comparison of angiographic outcomes","volume":"9","author":"Zhao","year":"2018","journal-title":"Front Neurol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.3171\/2023.2.JNS222649","article-title":"A long-term study of posterior circulation changes after revascularization in patients with moyamoya disease","volume":"139","author":"Bao","year":"2023","journal-title":"J Neurosurg"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1007\/s00701-020-04599-w","article-title":"Intraoperative transit-time ultrasonography combined with FLOW800 predicts the occurrence of cerebral hyperperfusion syndrome after direct revascularization of moyamoya disease: a preliminary study","volume":"163","author":"Yang","year":"2021","journal-title":"Acta Neurochir"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.jocn.2017.09.020","article-title":"Characteristics of cerebral hemodynamics assessed by CT perfusion in moyamoya disease","volume":"47","author":"Sasagawa","year":"2018","journal-title":"J Clin Neurosci"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1632626\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T11:01:04Z","timestamp":1755255664000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1632626\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,15]]},"references-count":22,"alternative-id":["10.3389\/fneur.2025.1632626"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1632626","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,15]]},"article-number":"1632626"}}