Comparative analysis of the efficacy of double-barrel versus single-branch STA-MCA bypass in the treatment of moyamoya disease: Does double-barrel bypass offer any advantages?

Abstract Background By comparing the effectiveness of the double-barrel and single-branch STA-MCA bypass in treating moyamoya disease, investigate whether the double-barrel bypass is more advantageous. Methods An analysis of the clinical records of patients with moyamoya disease treated with surgery was conducted retrospectively and divided into two groups: double-barrel bypass and single-branch bypass. Preoperative and postoperative rates of intracerebral hemorrhage, cerebral infarction, epilepsy, transient neurological deficits (TNEs), and mRS score were compared. Comparing changes in cerebral computed tomography perfusion (CTP) values of surgical side MCA pre-operation, one week and six months postoperatively between the two groups or within the same group was also performed. Results A total of 48 patients were enrolled, including 22 in the double-barrel group and 26 in the single-branch group. Between the two groups, there were no significant differences in postoperative hemorrhage, cerebral infarction, epilepsy, TNEs, mRS scores 6 months postoperatively, or CTP values 6 months postoperatively. Compared with preoperative values, the cerebral perfusion value of two groups decreased one week after surgery, but it improved six months later. Conclusions Both STA-MCA bypass methods can effectively improve cerebral blood perfusion and achieve therapeutic goals. Double-barrel bypass does not increase the risk of perioperative cerebral hemorrhage, infarctions, epilepsies, or TNEs, but it does show no significant advantages over single-branch bypass. As one surgical option for some patients with moyamoya disease, we believe double-barrel bypass can be used, but its priority is not greater than single-branch bypass.