title: The Efficacy of Single Barrel Superficial Temporal Artery-middle Cerebral Artery Bypass in Treatment of Adult Patients with Ischemic-type Moyamoya Disease.
abstract: OBJECTIVE
  So far, there is no study answering the question of which type of surgical technique is practically the most useful in the treatment of adult patients with ischemic type moyamoya disease (MMD). We evaluated the efficacy of single barrel superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in the treatment of adult patients with ischemic type MMD by retrospectively collecting clinical and radiological data.
  
  
  METHODS
  A retrospective review identified 31 adult patients who underwent 43 single barrel STA-MCA bypass procedures performed for treatment of ischemic-type MMD between 2006 and 2014. The male to female ratio was 17:14 and the mean age was 41 years (range, 21-65 years). Peri-operative complications, angiographic and clinical outcomes were analyzed retrospectively.
  
  
  RESULTS
  The permanent neurological morbidity and mortality rates were 2.3% and 0%, respectively. During the observation period of a mean of 35 months (range, 12-73 months), 29 patients (93.5%) had no further cerebrovascular events and transient ischemic attack occurred in two patients (6.5%), resulting in an annual stroke risk of 2.2%. Follow-up computed tomography perfusion (CTP) (mean, 18.4 months after surgery) documented improved cerebral hemodynamics in the revascularized hemispheres (p< 0.001). Post-operative patency was clearly verified in 38 bypasses (88.4%) of 43 bypasses on follow-up imaging (mean, 16.5 months).
  
  
  CONCLUSIONS
  Our results suggest that single barrel STA-MCA bypass with wide dural opening is safe and durable method of cerebral revascularization in adult patients with ischemic type MMD and can be considered as a potential treatment option for adult patients with ischemic type MMD.
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Mahnjeong
authors.initials: M
authors.lastname: Ha
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Chang Hwa
authors.initials: CH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Jae Il
authors.initials: JI
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Seung Heon
authors.initials: SH
authors.lastname: Cha
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Sang Weon
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Jun Kyeung
authors.identifier: 0000-0002-5652-7659
authors.initials: JK
authors.lastname: Ko
keywords: Adult; Bypass surgery; Ischemia; Moyamoya disease; Perfusion