Preliminary analysis of long-term prognosis outcomes of modified extracranial-intracranial bypass reconstruction for adult ischemic moyamoya disease

This retrospective cohort study compared long-term outcomes between modified extracranial-intracranial bypass (mECIC) and encephalo-duro-arterio-myo-synangiosis (EDAMS) in adults with ischemic moyamoya disease. Among 50 patients analyzed (mECIC: n = 18; EDAMS: n = 32), the mECIC group demonstrated better neurological recovery, with 88.9% achieving functional independence (mRS ≤ 2) versus 62.5% in the EDAMS group ( p = 0.018) at 60-month follow-up. Cognitive performance, assessed by the Montreal Cognitive Assessment (MoCA), showed greater improvement in the mECIC cohort (ΔMoCA: +8.2 ± 1.5 vs. + 5.1 ± 1.2 points; p < 0.001), accompanied by more pronounced hemodynamic restoration including higher cerebral blood flow (46.32 ± 6.70 vs. 40.19 ± 5.72 mL/100 g/min; p = 0.003) and greater flow augmentation (ΔCBF: +18.09 ± 9.32 vs. + 12.05 ± 6.77 mL/100 g/min; p = 0.02). The mECIC procedure was associated with longer stroke-free survival (HR = 3.48; p = 0.03). The mECIC revascularization, associated with improved long-term outcomes, may represent a valuable therapeutic approach for the long-term management of ischemic moyamoya disease in adults.