Wang Guoqing, Zhang Xiaoyang, Feng Mengzhao, Liu Xianzhi, Guo Fuyou
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Craniofac Surg. 2017 Nov;28(8):2113-2116. doi: 10.1097/SCS.0000000000004004.
It remains controversial about the optimal treatment of adult hemorrhagic moyamoya disease (MMD). In this study, the authors performed a meta-analysis to determine whether surgical treatment of adult hemorrhagic MMD is superior to conservative treatment.
A systematic search of the PubMed, EMBASE, and Cochrane Central databases was performed for articles published until May 2017. Randomized-controlled trials and cohort studies about the efficacy of surgical treatment and conservative treatment in patients with hemorrhagic MMD at 16 years of age or older were selected. Recurrent stroke incidence including hemorrhagic and ischemic events at the end of the follow-up period was calculated between the 2 groups with a 95% confidence interval (CI).
A total of 3 articles (including 146 patients) were included in the meta-analysis. There were significant differences between the 2 groups when the authors compared the overall recurrent stroke rate at the end of the follow-up period. Surgical treatment significantly reduced the risk of stroke (risk ratio, 0.43; 95% CI, 0.24-0.76; P = 0.004).
The current meta-analysis suggests that surgical treatment is better for conservative treatment in adult hemorrhagic MMD with recurrent stroke rate. Future studies are required to confirm this conclusion.
成人出血性烟雾病（MMD）的最佳治疗方案仍存在争议。在本研究中，作者进行了一项荟萃分析，以确定成人出血性MMD的手术治疗是否优于保守治疗。
对PubMed、EMBASE和Cochrane Central数据库进行系统检索，查找截至2017年5月发表的文章。选择关于16岁及以上出血性MMD患者手术治疗和保守治疗疗效的随机对照试验和队列研究。计算两组在随访期末复发性卒中发生率，包括出血性和缺血性事件，95%置信区间（CI）。
荟萃分析共纳入3篇文章（包括146例患者）。当作者比较随访期末总体复发性卒中率时，两组之间存在显著差异。手术治疗显著降低了卒中风险（风险比，0.43；95%CI，0.24 - 0.76；P = 0.004）。
当前的荟萃分析表明，对于有复发性卒中率的成人出血性MMD，手术治疗优于保守治疗。需要进一步的研究来证实这一结论。
