Perioperative management for patients with moyamoya disease: complications’ definition, technical advances, and outcomes

OBJECTIVE We aimed to present our experience with the complications’ definition, technical advances, and outcomes patients who underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass combined with encephalo-duro-myo-synangiosis (EDMS) surgery. METHODS STA-MCA combined with EDMS surgery was certified effective in patients with MMD who were treated by an experienced team. Patients received conventional management from Dec 2012 to April 2018 in our hospital. After a perioperative paradigm had been developed, patients received comprehensive management from May 2018 to June 2023. RESULTS A total of 240 MMD patients who underwent STA-MCA combined with EDMS surgery were sampled and divided into two cohorts according to the chronological order. Among them, 132 (55.0%) patients underwent routine management mode, and 108 (45.0%) patients underwent the proposed perioperative management mode. The clinical characteristics of the two cohorts was homogenous, and the postoperative outcomes are differential. We redefined the surgical complications of STA-MCA combined with EDMS surgery range from a mild complication lasting a few weeks to a serious, reversible stage lasting months or years, and to a terrible, irreversible condition that causing long-term unfavorable outcome or neurological deterioration. Accordingly, patients who received our proposed paradigm presented a significantly decreased incidence of grade I and grade II complications. Although there was no statistical difference in grade III complications, patients in developed cohort tend to have a lower incidence of 6-months unfavorable outcomes. CONCLUSIONS This evolved perioperative paradigm could effectively prevent risk factors and reduce related complications of STA-MCA combined with EDMS surgery.