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A critical appraisal of bypass surgery in moyamoya disease.
Therapeutic Advances in Neurological Disorders ( IF 5.9 ) Pub Date : 2020-05-26 , DOI: 10.1177/1756286420921092
Michael Moussouttas 1 , Igor Rybinnik 2
Affiliation  

Moyamoya disease (MMD) is a complex cerebrovascular disorder about which little is known. Conventionally, revascularization surgery is recommended for patients, despite an absence of conclusive data from adequate clinical trials. Underscoring the uncertainty that exists in treating MMD patients, investigators continue to present data comparing revascularization with conservative or medical management, most of which originates from East Asia where MMD is most prevalent. The purpose of this manuscript is to review contemporary large case series, randomized trials, and recent meta-analyses that compare surgical and medical treatments in adult patients with MMD, and to critically analyze the modern literature in the context of current practice standards. Data from the available literature is limited, but revascularization seems superior to conservative therapy in adult patients presenting with hemorrhage, and in preventing future hemorrhages. Conversely, evidence that surgery is superior to medical therapy is not convincing in adult patients presenting with cerebral ischemia, or for the prevention of future ischemic events. In contrast to East Asian populations, MMD in Europe and in the Americas is predominantly an ischemic disease that presents in adulthood. Adequate multinational trials are warranted.



中文翻译:

对烟雾病绕行手术的重要评估。

Moyamoya病(MMD)是一种复杂的脑血管疾病,对此鲜为人知。按照惯例,尽管缺乏足够的临床试验结论性数据,仍建议患者进行血运重建手术。强调在治疗MMD患者方面存在不确定性,研究人员继续提供将血运重建与保守治疗或医学治疗进行比较的数据,其中大多数来自MMD最普遍的东亚。本手稿的目的是回顾当代大型病例系列研究,随机试验以及近期的荟萃分析,这些研究比较了成年MMD患者的手术和药物治疗,并在当前实践标准的背景下批判性地分析了现代文献。现有文献中的数据有限,但是对于有出血并预防未来出血的成年患者,血运重建似乎优于保守治疗。相反,对于表现出脑缺血或预防未来缺血事件的成年患者,不能说手术优于药物治疗的证据令人信服。与东亚人口相反,欧洲和美洲的MMD主要是成年后出现的局部缺血性疾病。有必要进行充分的跨国试验。在欧洲和美洲,MMD主要是成年后出现的局部缺血性疾病。保证足够的跨国试验。在欧洲和美洲,MMD主要是成年后出现的局部缺血性疾病。保证足够的跨国试验。

更新日期:2020-05-26
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