The clinical and hemodynamics of side-to-side anastomosis for superficial temporal artery-middle cerebral artery bypass in adult patients with moyamoya disease: a prospective cohort study

Zhiyong Shi¹Zhongren Deng²Xinhua Chen¹LINGYUN WU¹Wei Li¹Juan Wang¹Yi Liu³Dong Zhang⁴Yi Wang^1*Chunhua Hang¹Yongbo Yang^1*

• ¹Neurosurgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital, Nanjing, China
• ²Department of Neurosurgery, Huai'an Hongze District People's Hospital, Huai An, China
• ³Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
• ⁴Department of Neurosurgery, Beijing Hospital, Beijing, China

Objective. Superficial temporal artery-middle cerebral artery (STA-MCA) bypass, characterized by side-to-side (S-S) anastomosis, was beneficial in reducing incidence of postoperative complication and recurrent stroke in patients with moyamoya disease (MMD). However, the safety and efficacy of this unconventional S-S procedure remained unclear. This research aimed to investigate clinical and hemodynamic outcomes associated with S-S technique. Method. Clinical and radiographic data were collected from 50 adult MMD patients (50 hemispheres), with 23 cases using S-S and 27 cases using end-to-side (E-S) STA-MCA bypass. The patients' 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).Result. There was no significant difference between S-S and E-S group in baseline characteristics, postoperative complication, bypass patency rate, neovascularization, and modified Rankin Scale (mRS) score (P>0.05). However, significant difference was noted in bypass time and anastomosis size between E-S and S-S group (P<0.001).Intraoperative MDU analysis demonstrated that mean velocity value (MVV) of recipient artery entering sylvian (RA.ES) and MVV folds change in donor vessels were significantly higher in S-S group compared to E-S group (P<0.05). Postoperative CTP analysis showed no difference in volume of infarct core, hypoperfusion, and penumbra between the groups (P>0.05). Conclusion. The S-S technique demonstrated different intraoperative self-flow regulation capacity compared to traditional E-S technique, while achieving no superiority in postoperative hemispheric perfusion and clinical outcome. The choice of bypass procedure should be individualized.