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September 5, 2026Journal of Neurological Surgery Part B Skull Base

Salvage Occipital Artery-Middle Cerebral Artery Bypass for Refractory Moyamoya Disease: Systematic Review and Illustrative Case of Bilateral Revascularization

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Authors

DCDavid ChoGDG DuránCGCory Greer

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Overview

Systematic review and case report demonstrates high patency and symptom resolution in refractory Moyamoya disease, suggesting viability after failed primary revascularization.

Key Points

  • To evaluate the efficacy and clinical outcomes of salvage occipital artery-middle cerebral artery (OA-MCA) bypass in patients with refractory Moyamoya disease who failed initial revascularization.
  • Presented an illustrative case of a 55-year-old woman undergoing bilateral salvage OA-MCA bypass after failed bilateral superficial temporal artery to middle cerebral artery (STA-MCA) revascularization.
  • Conducted a systematic review across MEDLINE and Embase through March 2026, screening 134 citations to identify 5 studies meeting inclusion criteria (N=19 total patients).
  • All bypasses achieved radiographic patency at a mean follow-up of 24 months, with no reports of recurrent cerebral ischemia.
  • Complete or near-complete symptom resolution occurred in 63.2% (12/19) of cases, with clinical improvement observed in the remaining 36.8% (7/19).
  • Cerebral perfusion normalized in 31.6% (6/19) and improved in 57.9% (11/19), while complications included two wound infections (10.5%) and one symptomatic treatment failure (5.3%).

Cite This Study

Cho et al. (2026) studied this question.

synapsesocial.com/papers/6a9bd4436b95aff0620ebd53https://doi.org/10.1055/a-2949-3600
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Efficacy of Occipital Artery–Encephaloduroarteriosynagiosis for Posterior Circulation Ischemia in Moyamoya Disease2026 · 1 citations
  2. 2Impact of posterior cerebral artery involvement on long-term clinical and social outcome of pediatric moyamoya disease2013 · 87 citations
  3. 3Late (5–20 years) outcomes after STA-MCA anastomosis and encephalo-duro-myo-arterio-pericranial synangiosis in patients with moyamoya disease2020 · 68 citations
  4. 4Double-barrel STA-MCA bypass for cerebral revascularization: lessons learned from a 10-year experience2021 · 40 citations
  5. 5Clinical Significance of Posterior Circulation Changes after Revascularization in Patients with Moyamoya Disease2009 · 54 citations