Reports of long-term outcomes following combined direct and indirect bypass for moyamoya disease are sparse. Cho and colleagues report on 77 treated hemispheres in 60 patients with a mean follow up of approximately 6 years. Karnofsky Performance and modified Rankin Scale improved until 6 months after surgery and remained stable thereafter. The revascularization area significantly increased in the long-term period compared with that in the short-term period. Cerebral blood flow in the territory of the middle cerebral artery improved in the short-term period compared with that in the preoperative period and thereafter became stable. The annual risks of symptomatic hemorrhage and infarction were 0.4% and 0.2%, respectively, in the operated hemispheres. In this study combined revascularization surgery resulted in satisfactory long-term improvement in clinical, angiographic, and hemodynamic states with a low risk of stroke.
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