{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:09:13Z","timestamp":1791216553530,"version":"4.1.0"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T00:00:00Z","timestamp":1660867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Moyamoya disease (MMD) is a chronic, progressive cerebrovascular disease involving the occlusion or stenosis of the terminal portion of the internal carotid artery (ICA) and the proximal anterior and middle cerebral arteries. Adults with MMD have been shown to progressively accumulate neurological and cognitive deficits without treatment, with a mortality rate double that of pediatric patients with MMD. Surgical intervention is the mainstay of treatment to prevent disease progression and improve clinical outcomes. Several different types of bypasses can be utilized for revascularization in MMD, including indirect, direct, and combined forms of extracranial-to-intracranial (EC-IC) bypass. Overall, the choice of appropriate technique requires consideration of the age of the patient, preoperative hemodynamics, neurologic status, and territories most at risk and in need of revascularization. Here, we will review the indications and surgical techniques for the treatment of adult MMD. Step-by-step instructions for performing several bypass variants with technical pearls are discussed.<\/jats:p>","DOI":"10.3389\/fsurg.2022.966430","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T08:19:43Z","timestamp":1660897183000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":20,"title":["Surgical techniques and indications for treatment of adult moyamoya disease"],"prefix":"10.3389","volume":"9","author":[{"given":"Vincent N.","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara A.","family":"Parikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Motiwala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Erin Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Barats","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Milton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nickalus R.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"B1","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","journal-title":"Arch Neurol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1161\/01.str.14.1.104","article-title":"Moyamoya disease\u2013a review","volume":"14","author":"Suzuki","year":"1983","journal-title":"Stroke"},{"key":"B3","doi-asserted-by":"publisher","first-page":"37","DOI":"10.12691\/ajmcr-2-5-5","article-title":"Hypogenesis of bilateral internal carotid arteries","volume":"9","author":"Takeuchi","year":"1957","journal-title":"No To Shinkei"},{"key":"B4","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.wneu.2016.04.083","article-title":"Perioperative complications and long-term outcomes after bypasses in adults with moyamoya disease: a systematic review and meta-analysis","volume":"92","author":"Sun","year":"2016","journal-title":"World Neurosurg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"221","DOI":"10.2176\/nmc.19.221","article-title":"[Moyamoya disease(author\u2019s transl)]","volume":"19","author":"Nishimoto","year":"1979","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1161\/STROKEAHA.113.004386","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan adult moyamoya trial","volume":"45","author":"Miyamoto","year":"2014","journal-title":"Stroke"},{"key":"B7","doi-asserted-by":"publisher","first-page":"480","DOI":"10.3171\/2017.5.JNS17353","article-title":"Direct versus indirect revascularization in the treatment of moyamoya disease","volume":"129","author":"Park","year":"2018","journal-title":"J Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1290","DOI":"10.1161\/STROKEAHA.117.020566","article-title":"Feasibility of multiple burr hole with erythropoietin in acute moyamoya patients","volume":"49","author":"Hong","year":"2018","journal-title":"Stroke"},{"key":"B9","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/s0090-3019(97)00122-5","article-title":"Cerebral revascularization using omentum and muscle free flap for ischemic cerebrovascular disease","volume":"49","author":"Yoshioka","year":"1998","journal-title":"Surg Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"708","DOI":"10.2176\/nmc.31.708","article-title":"Effects of encephalo-duro-arterio-synangiosis on childhood moyamoya patients\u2013swift disappearance of ischemic attacks and maintenance of mental capacity","volume":"31","author":"Matsushima","year":"1991","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"E114","DOI":"10.1093\/neuros\/nyab165","article-title":"Commentary: direct vs indirect revascularization in a north American cohort of moyamoya disease","volume":"89","author":"Ahmed","year":"2021","journal-title":"Neurosurgery"},{"key":"B12","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/s0079-6123(08)61469-7","article-title":"Microangeional surgery and its techniques","volume":"30","author":"Donaghy","year":"1968","journal-title":"Prog Brain Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"E437","DOI":"10.1093\/ons\/opab010","article-title":"A 1-donor 2-recipient superficial temporal artery-middle cerebral artery bypass for moyamoya syndrome: 2-dimensional operative video","volume":"20","author":"Khan","year":"2021","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"B14","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":"2021","journal-title":"J Neurosurg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"909","DOI":"10.3171\/2019.12.JNS192938","article-title":"Late (5-20 years) outcomes after sta-mca anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease","volume":"134","author":"Kuroda","year":"2020","journal-title":"J Neurosurg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"245","DOI":"10.2176\/nmc.52.245","article-title":"Research Committee. on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis; Health Labour Sciences Research Grant for Research on Measures for Infractable Diseases. Guidelines for Diagnosis and Treatment of Moyamoya Disease (Spontaneous Occlusion of the Circle of Willis)","volume":"52","year":"2012","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.wneu.2018.12.183","article-title":"A comprehensive meta-analysis for bypass surgery in adult moyamoya","author":"Yan","year":"2019","journal-title":"World Neurosurg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"171","DOI":"10.5137\/1019-5149.JTN.22598-18.3","article-title":"Effect of surgery on the long-term functional outcome of moyamoya disease: a meta-analysis","volume":"29","author":"Zhong","year":"2019","journal-title":"Turk Neurosurg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1578","DOI":"10.3171\/2020.3.JNS192847","article-title":"Direct versus indirect bypass procedure for the treatment of ischemic moyamoya disease: results of an individualized selection strategy","volume":"134","author":"Nielsen","year":"2020","journal-title":"J Neurosurg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e557","DOI":"10.1016\/j.wneu.2018.06.076","article-title":"Hemorrhagic moyamoya disease treatment: a network meta-analysis","volume":"117","author":"Ding","year":"2018","journal-title":"World Neurosurg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e2356","DOI":"10.1002\/brb3.2356","article-title":"A meta-analysis of comparisons of Various surgical treatments for moyamoya diseases","volume":"11","author":"Lin","year":"2021","journal-title":"Brain Behav"},{"key":"B22","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 M","year":"2020","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"B23","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1016\/j.wneu.2019.04.062","article-title":"Meta-Analysis of prognosis of different treatments for symptomatic moyamoya disease","volume":"127","author":"Li","year":"2019","journal-title":"World Neurosurg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1007\/s00701-012-1325-1","article-title":"Long-term follow-up results in 142 adult patients with moyamoya disease according to management modality","volume":"154","author":"Lee","year":"2012","journal-title":"Acta Neurochir (Wien)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"191","DOI":"10.7461\/jcen.2013.15.3.191","article-title":"Thirteen-year experience of 44 patients with adult hemorrhagic moyamoya disease from a single institution: clinical analysis by management modality","volume":"15","author":"Choi","year":"2013","journal-title":"J Cerebrovasc Endovasc Neurosurg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"432","DOI":"10.3171\/2014.1.JNS13946","article-title":"The frequency of postoperative stroke in moyamoya disease following combined revascularization: a single-university series and systematic review","volume":"121","author":"Kazumata","year":"2014","journal-title":"J Neurosurg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1227\/neu.0000000000001201","article-title":"Synergistic interactions between direct and indirect bypasses in combined procedures: the significance of indirect bypasses in moyamoya disease","volume":"80","author":"Uchino","year":"2017","journal-title":"Neurosurgery"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1227\/01.NEU.0000369606.00861.91","article-title":"Novel bypass surgery for moyamoya disease using pericranial flap: its impacts on cerebral hemodynamics and long-term outcome","volume":"66","author":"Kuroda","year":"2010","journal-title":"Neurosurgery"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1007\/s10143-020-01393-1","article-title":"Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome","volume":"44","author":"Fiaschi","year":"2021","journal-title":"Neurosurg Rev"},{"key":"B30","doi-asserted-by":"publisher","first-page":"216","DOI":"10.7461\/jcen.2012.14.3.216","article-title":"Angiographic results of indirect and combined bypass surgery for adult moyamoya disease","volume":"14","author":"Choi","year":"2012","journal-title":"J Cerebrovasc Endovasc Neurosurg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.neurol.2014.08.007","article-title":"Surgical management of moyamoya disease and syndrome: current concepts and personal experience","volume":"171","author":"Thines","year":"2015","journal-title":"Rev Neurol (Paris)"},{"key":"B32","doi-asserted-by":"publisher","first-page":"106869","DOI":"10.1016\/j.clineuro.2021.106869","article-title":"Postoperative neovascularization, cerebral hemodynamics, and clinical prognosis between combined and indirect bypass revascularization procedures in hemorrhagic moyamoya disease","volume":"208","author":"Sun","year":"2021","journal-title":"Clin Neurol Neurosurg"},{"key":"B33","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","journal-title":"J Neurosurg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.3171\/2014.7.JNS132434","article-title":"Outcome in adult patients with hemorrhagic moyamoya disease after combined extracranial-intracranial bypass","volume":"121","author":"Jiang","year":"2014","journal-title":"J Neurosurg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"462","DOI":"10.2176\/nmc.46.462","article-title":"Simultaneous superficial temporal artery to middle cerebral or anterior cerebral artery bypass with pan-synangiosis for moyamoya disease covering both anterior and middle cerebral artery territories","volume":"46","author":"Ishikawa","year":"2006","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B36","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1161\/STROKEAHA.115.008220","article-title":"Role of and indications for bypass surgery after carotid occlusion surgery study (coss)?","volume":"47","author":"Esposito","year":"2016","journal-title":"Stroke"},{"key":"B37","doi-asserted-by":"publisher","first-page":"ons30","DOI":"10.1227\/NEU.0b013e318285b587","article-title":"Double-barrel bypass for cerebral ischemia: technique, rationale, and preliminary experience with 10 consecutive cases","volume":"73","author":"Duckworth","year":"2013","journal-title":"Neurosurgery"},{"key":"B38","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1179\/1743132814Y.0000000351","article-title":"An update on the diagnosis and treatment of adult moyamoya disease taking into consideration controversial issues","volume":"36","author":"Kim","year":"2014","journal-title":"Neurol Res"},{"key":"B39","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":"B40","doi-asserted-by":"publisher","first-page":"132","DOI":"10.3171\/jns.2005.102.1.0132","article-title":"Microsurgical anatomy of cerebral revascularization. Part II: posterior circulation","volume":"102","author":"Kawashima","year":"2005","journal-title":"J Neurosurg"},{"key":"B41","doi-asserted-by":"publisher","first-page":"180","DOI":"10.3171\/jns.1989.71.2.0180","article-title":"Cranial burr hole for revascularization in moyamoya disease","volume":"71","author":"Endo","year":"1989","journal-title":"J Neurosurg"},{"key":"B42","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3109\/02688697.2015.1071318","article-title":"Therapeutic effect of multiple burr hole operation combined with dural inversion and periosteal synangiosis for moyamoya disease","volume":"29","author":"Zhao","year":"2015","journal-title":"Br J Neurosurg"},{"key":"B43","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2176\/nmc.17pt1.29","article-title":"A surgical treatment of \u201cmoyamoya\u201d disease \u201cencephalo-myo synangiosis\u201d","volume":"17","author":"Karasawa","year":"1977","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B44","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.wneu.2018.08.171","article-title":"Novel indirect revascularization technique with preservation of temporal muscle function for moyamoya disease encephalo-duro-fascio-arterio-pericranial-synangiosis: a case series and technical note","volume":"120","author":"Noguchi","year":"2018","journal-title":"World Neurosurg"},{"key":"B45","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1227\/00006123-199304000-00006","article-title":"Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, Its follow-up, clinical results, and angiograms","volume":"32","author":"Kinugasa","year":"1993","journal-title":"Neurosurgery"},{"key":"B46","doi-asserted-by":"publisher","first-page":"719","DOI":"10.3171\/jns.1997.86.4.0719","article-title":"Dural inversion procedure for moyamoya disease. Technical note","volume":"86","author":"Dauser","year":"1997","journal-title":"J Neurosurg"},{"key":"B47","doi-asserted-by":"publisher","first-page":"S115","DOI":"10.1016\/s0303-8467(97)00069-3","article-title":"Revascularization with split duro-encephalo-synangiosis in the pediatric moyamoya disease\u2013surgical result and clinical outcome","volume":"99","author":"Kashiwagi","year":"1997","journal-title":"Clin Neurol Neurosurg"},{"key":"B48","first-page":"444","article-title":"Intracranial transplantation of the omentum for cerebrovascular moyamoya disease: a two-year follow-up study","volume":"14","author":"Karasawa","year":"1980","journal-title":"Surg Neurol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1227\/NEU.0000000000000119","article-title":"Less invasive pedicled omental-cranial transposition in pediatric patients with moyamoya disease and failed prior revascularization","volume":"10","author":"Navarro","year":"2014","journal-title":"Neurosurgery"},{"key":"B50","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1016\/j.nec.2017.02.004","article-title":"Direct versus indirect bypass for moyamoya disease","volume":"28","author":"Liu","year":"2017","journal-title":"Neurosurg Clin N Am"},{"key":"B51","doi-asserted-by":"publisher","first-page":"e10994","DOI":"10.7759\/cureus.10994","article-title":"Moyamoya: an update and review","volume":"12","author":"Berry","year":"2020","journal-title":"Cureus"},{"key":"B52","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1007\/s007010050313","article-title":"Efficacy of direct revascularization in adult moyamoya disease: haemodynamic evaluation by positron emission tomography","volume":"141","author":"Morimoto","year":"1999","journal-title":"Acta Neurochir (Wien)"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1788","DOI":"10.3171\/2015.6.JNS151105","article-title":"Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia","volume":"124","author":"Kim","year":"2016","journal-title":"J Neurosurg"},{"key":"B54","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1093\/ons\/opy396","article-title":"Single vessel double anastomosis for flow augmentation - a novel technique for direct extracranial to intracranial bypass surgery","volume":"17","author":"Arnone","year":"2019","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"B55","doi-asserted-by":"publisher","first-page":"578","DOI":"10.7150\/ijms.15390","article-title":"Progress on complications of direct bypass for moyamoya disease","volume":"13","author":"Yu","year":"2016","journal-title":"Int J Med Sci"},{"key":"B56","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1093\/ons\/opx119","article-title":"Double-barrel superficial temporal artery-middle cerebral artery bypass: can it be considered \u201chigh-flow?\u201d","volume":"14","author":"Cherian","year":"2018","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"B57","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1093\/ons\/opy091","article-title":"Side-to-side and end-to-side double anastomosis using the parietal-branch of the superficial temporal artery-a novel technique for extracranial to intracranial bypass surgery: 3-dimensional operative video","volume":"16","author":"Arnone","year":"2019","journal-title":"Oper Neurosurg (Hagerstown)"},{"key":"B58","doi-asserted-by":"publisher","first-page":"S142","DOI":"10.1016\/s0303-8467(97)00075-9","article-title":"Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications","volume":"99","author":"Houkin","year":"1997","journal-title":"Clin Neurol Neurosurg"},{"key":"B59","doi-asserted-by":"publisher","first-page":"537","DOI":"10.3171\/jns.1988.68.4.0537","article-title":"Pitfalls in the surgical treatment of moyamoya disease. Operative techniques for refractory cases","volume":"68","author":"Miyamoto","year":"1988","journal-title":"J Neurosurg"},{"key":"B60","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s007010050035","article-title":"Neovascularization (angiogenesis) after revascularization in moyamoya disease. Which technique is most useful for moyamoya disease?","volume":"142","author":"Houkin","year":"2000","journal-title":"Acta Neurochir (Wien)"},{"key":"B61","doi-asserted-by":"publisher","first-page":"333","DOI":"10.2176\/nmc.52.333","article-title":"Surgical treatment of moyamoya disease in adults: combined direct and indirect vs. Indirect bypass surgery","volume":"52","author":"Kim","year":"2012","journal-title":"Neurol Med Chir (Tokyo)"},{"key":"B62","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1161\/01.str.28.6.1170","article-title":"Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease","volume":"28","author":"Ishikawa","year":"1997","journal-title":"Stroke"},{"key":"B63","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1055\/s-2005-868160","article-title":"Surgical management of moyamoya syndrome","volume":"15","author":"Smith","year":"2005","journal-title":"Skull Base"},{"key":"B64","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ons\/opx086","article-title":"Bipolar cutting method: another technique for harvesting donor artery with histological investigation","volume":"14","author":"Tokugawa","year":"2018","journal-title":"Operative Neurosurgery"},{"key":"B65","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/ons\/opaa276","article-title":"Controversies and advances in adult intracranial bypass surgery in 2020","volume":"20","author":"Raper","year":"2020","journal-title":"Oper Neurosurg (Hagerstown)"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.966430\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T08:19:47Z","timestamp":1660897187000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.966430\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,19]]},"references-count":65,"alternative-id":["10.3389\/fsurg.2022.966430"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.966430","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,19]]},"article-number":"966430"}}