Effects of different surgical modalities on the clinical outcome of patients with moyamoya disease: a prospective cohort study

OBJECTIVEBypass surgery is the most common treatment for moyamoya disease (MMD), but there is controversy over which surgical modality is best. The objective of this study was to evaluate the clinical outcome of patients with MMD after undergoing different surgical modalities.METHODSA series of 696 consecutive MMD patients treated between June 2009 and May 2015 were screened in this prospective cohort study. Patients who did not undergo revascularization surgeries and those who underwent different surgical modalities in bilateral hemispheres were excluded. Finally, 529 patients who were observed for at least 12 months were included: 438 patients underwent unilateral surgery, and 91 patients underwent bilateral surgery. Of these, 241 patients underwent direct bypass (DB); 81, a combined bypass (CB); and 207, an indirect bypass (IB). Three clinical outcomes were evaluated and compared between surgical groups: recurrent stroke events, modified Rankin Scale (mRS) scores, and change in the main symptoms.RESULTSThe mean follow-up period was 40 months. During the follow-up period, recurrent stroke was observed in 43 patients, including 15 patients with hemorrhage, 26 patients with ischemia (transient ischemic attack in 19 patients and infarction in 7 patients), and 2 patients with both hemorrhage and cerebral infarction. Kaplan-Meier analysis showed that patients who underwent a CB or DB had a longer ischemia-free time than those who underwent IB (p = 0.013); however, there was no significant difference in the hemorrhage-free time between the different surgical modalities (p = 0.534). A good neurological status (mRS score ≤ 2) was achieved in 495 patients (93.6%) and was significantly achieved by more children (98.2%) than adults (92.3%; p = 0.022). Surgical modalities were not significantly associated with outcome neurological status (p = 0.860). Moreover, improvement in symptoms was observed in 449 patients (84.9%) and was also significantly more common in children (93.0%) than in adults (82.7%; p = 0.006). No significant difference was observed between the different surgical modalities (p = 0.548).CONCLUSIONSCB and DB are more effective at preventing recurrent ischemic strokes than IB. However, there is no evidence that these 3 surgical modalities demonstrate significant differences in preventing recurrent hemorrhage.

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117 Effects of Different Surgical Modalities on Clinical Outcome of Moyamoya Disease: A Prospective Cohort Study

Neurosurgery ◽

10.1093/neuros/nyx417.117 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 225-225 ◽

Cited By ~ 2

Author(s):

Xiaofeng Deng ◽

Dong Zhang ◽

Yan Zhang ◽

Rong Wang ◽

Faliang Gao ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Moyamoya Disease ◽

Prospective Cohort ◽

Recurrent Stroke ◽

Neurological Status ◽

Free Time ◽

Significant Difference ◽

Surgical Modality

Abstract INTRODUCTION Bypass surgery is the major treatment for Moyamoya disease (MMD), but which surgical modality is superior still remains controversial. METHODS This prospective cohort study screened a series of 696 consecutive MMD patients from 2009 to 2015. Patients without revascularization surgeries or with different surgical modalities on bilateral hemispheres were excluded. Finally, 529 patients who were followed up for with at least 12 months were included, with 438 patients undergoing unilateral surgeries and 91 patients undergoing bilateral surgeries. Of these, 241 patients received direct bypass (DB), 81 patients received combined bypass (CB) and 207 patients received indirect bypass (IB). Three clinical outcomes were evaluated and compared between different surgical groups, including recurrent stroke events, modified Rankin Scale (mRS) scores and change of main symptoms. RESULTS >The mean follow-up period was 40 months. During the follow-up period, recurrent stroke events were observed in 43 patients, including 15 patients with hemorrhage, 26 patients with ischemia (TIA in 19 and infarction in 7) and 2 patients with both hemorrhage and cerebral infarction. Kaplan-Meier analysis showed that patients receiving CB and DB had longer ischemia-free time compared to patients with IB (P = 0.013). But there was no significant difference in hemorrhage-free time between different surgical modalities (P = 0.534). A good neurological status (mRS = 2) was achieved in 495 patients (93.6%), which was significantly more common in children (98.2%) than in adults (92.3%; P = 0.022). Surgical modalities were not significantly associated with neurological status outcome (P = 0.860). Moreover, improvement of symptoms was observed in 449 patients (84.9%), which was also significantly more common in children (93.0%) than in adults (82.7%; P = 0.006). No significant difference was observed between different surgical modalities, either (P = 0.548). CONCLUSION CB and DB are more effective to prevent recurrent ischemic strokes than IB. However, there is no evidence that these three surgical modalities had significant difference in preventing recurrent hemorrhage.

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Asymptomatic Cerebral Microbleeds in Adult Patients with Moyamoya Disease: A Prospective Cohort Study with 2 Years of Follow-Up

Cerebrovascular Diseases ◽

10.1159/000350203 ◽

2013 ◽

Vol 35 (5) ◽

pp. 469-475 ◽

Cited By ~ 23

Author(s):

Wen Sun ◽

Cuiping Yuan ◽

Wenhua Liu ◽

Yongkun Li ◽

Zhixin Huang ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Moyamoya Disease ◽

Prospective Cohort ◽

Cerebral Microbleeds ◽

Adult Patients

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Pelvic pain and early IUD discontinuation: a prospective cohort study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190850 ◽

2019 ◽

Vol 8 (3) ◽

pp. 792

Author(s):

Sharon R. Gerber ◽

Noah Natell ◽

Nora Doty ◽

Xiaoyu Liu ◽

Jessica R. Overbey ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Prospective Cohort Study ◽

Pelvic Pain ◽

Prospective Cohort ◽

Intrauterine Device ◽

Significant Difference ◽

History Of ◽

One Year

Background: The aim of the study is to assess if pelvic pain is a risk factor for intrauterine device (IUD) discontinuation within one year of placement.Methods: This is a prospective cohort study of women who had IUDs inserted at a family planning office for the primary intent of contraception. Baseline pelvic pain characteristics were assessed using a validated pelvic pain questionnaire. Women were contacted at 1 year to assess IUD continuation.Results: From February 1, 2014 to August 11, 2015 authors enrolled a sample of 179 women. Of the 179 enrolled,163 participants completed the questionnaire, 98 reported a history of baseline pelvic pain and 65 reported no history of baseline pelvic pain. 20 participants were lost to follow-up. 86 women in the pelvic pain and 57 in the no pelvic pain group were included in the final analysis. Discontinuation rates at one year follow up were 25.6% (22) and 35.1% (20) respectively. There was no significant difference in those with and without pelvic pain discontinuing IUDs at one year (p = 0.22).Conclusions: Baseline generalized pelvic pain may not be a risk factor for IUD discontinuation within one year of placement.

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Direct versus indirect bypasses for adult ischemic-type moyamoya disease: a propensity score–matched analysis

Journal of Neurosurgery ◽

10.3171/2017.2.jns162405 ◽

2018 ◽

Vol 128 (6) ◽

pp. 1785-1791 ◽

Cited By ~ 13

Author(s):

Xiaofeng Deng ◽

Faliang Gao ◽

Dong Zhang ◽

Yan Zhang ◽

Rong Wang ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Moyamoya Disease ◽

Recurrent Stroke ◽

Neurological Status ◽

Kaplan Meier ◽

Significant Difference ◽

Surgical Modality ◽

Direct Bypass

OBJECTIVEThe optimal surgical modality for moyamoya disease (MMD) remains unclear. The aim of this study was to compare the surgical effects of direct bypass (DB) and indirect bypass (IB) in the treatment of adult ischemic-type MMD.METHODSAdult patients with ischemic-type MMD who underwent either DB or IB from 2009 to 2015 were identified retrospectively from a prospective database. Patients lost to follow-up or with a follow-up period less than 12 months were excluded. Recurrent stroke events and modified Rankin Scale (mRS) scores at the last follow-up were compared between the 2 surgical groups after 1:1 propensity score matching.RESULTSA total of 220 patients were considered, including 143 patients who underwent DB and 77 patients who underwent IB. After propensity score matching, 70 pairs were obtained. The median follow-up period was 40.5 months (range 14–75 months) in the DB group and 31.5 months (range 14–71 months) in the IB group (p = 0.004). Kaplan-Meier analysis showed that patients who received DB had a longer stroke-free time (mean 72.1 months) compared with patients who received IB (mean 61.0 months) (p = 0.045). Good neurological status (mRS score ≤ 2) was achieved in 64 patients in the DB group (91.4%) and 66 patients in the IB group (94.3%), but there was no significant difference (p = 0.512).CONCLUSIONSAlthough neurological function outcome was not determined by the surgical modality, DB is more effective in preventing recurrent ischemic strokes than IB for adult ischemic-type MMD.

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AMIC for traumatic focal osteochondral defect of the talar shoulder: a 5 years follow-up prospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04506-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Christian Götze ◽

Christian Nieder ◽

Hanna Felder ◽

Christian Dominik Peterlein ◽

Filippo Migliorini

Keyword(s):

Cohort Study ◽

Clinical Outcome ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Secondary Outcome ◽

Collagen Membrane ◽

Osteochondral Defects ◽

Level Of Evidence ◽

The Mean

Abstract Background Autologous Matrix-Induced Chondrogenesis (AMIC) is addressed to osteochondral defects of the talus. However, evidence concerning the midterm efficacy and safety of AMIC are limited. This study assessed reliability and feasibility of AMIC at 60 months follow-up. We hypothesize that AMIC leads to good clinical outcome at midterm follow-up. Methods Surgeries were approached with an arthrotomy via malleolar osteotomy. A resorbable porcine I/III collagen membrane (Chondro-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) was used. Patients were followed at 24 and 60 months. The primary outcome of interest was to analyse the Foot Function Index (FFI), and the subscale hindfoot of the American Orthopaedic Foot and Ankle Score (AOFAS). Complications such as failure, revision surgeries, graft delamination, and hypertrophy were also recorded. The secondary outcome of interest was to investigate the association between the clinical outcome and patient characteristics at admission. Results Data from 19 patients were included. The mean age at admission was 47.3 ± 13.2 years, and the mean BMI 24.1 ± 4.9 kg/m2. 53% (10 of 19 patients) were female. At a mean of 66.2 ± 11.6 months, the FFI decreased at 24-months follow-up of 22.5% (P = 0.003) and of further 1.3% (P = 0.8) at 60-months follow-up. AOFAS increased at 24-months follow-up of 17.2% (P = 0.003) and of further 3.4 (P = 0.2) at 60-months follow-up. There were two symptomatic recurrences within the follow-up in two patients. There was evidence of a strong positive association between FFI and AOFAS at baseline and the same scores last follow-up (P = 0.001 and P = 0.0002, respectively). Conclusion AMIC enhanced with cancellous bone graft demonstrated efficacy and feasibility for osteochondral defects of the talus at five years follow-up. The greatest improvement was evidenced within the first two years. These results suggest that clinical outcome is influenced by the preoperative status of the ankle. High quality studies involving a larger sample size are required to detect seldom complications and identify prognostic factors leading to better clinical outcome. Level of evidence II, prospective cohort study.

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