Bypass Treatment versus EDAS for Moyamoya Disease: a systematic review
Ana Beatriz Ballesteros Bocchi, Anic Marques Verdi Ferreira, Julia Scaramal Mello, Lidia Cheidde, Paulo Henrique Pires de Aguiar
Abstract
Moyamoya disease (MMD) is a cerebrovascular disorder characterized by the formation of fragile collateral vessels, which leads to an increased risk of ischemic and hemorrhagic stroke. The principal treatment for MMD is surgical revascularization. This review compares two surgical modalities: direct bypass surgery and encephalo-duro-arterio-synangiosis (EDAS). A search was performed on PubMed, Embase, LILACS, and Cochrane. Inclusion required clinical studies published in English in a journal with an impact factor >1 since 2000, comparing direct versus EDAS in MMD patients. Efficacy was assessed using mRS, incidence of ischemic events, and rebleeding, while safety included complications. The review included 7 retrospective cohorts (n = 604): 224 (37.1%) direct, 312 (51.6%) EDAS, and 68 not specified. The incidence of ischemic and cerebral hemorrhagic events was generally higher in the indirect group, with similar results in overall functional improvement (mRS). However, patients undergoing direct bypass experienced higher surgical complication rates. Mortality was low across all studies, with slightly more deaths reported in the indirect group in one cohort. The current evidence suggests that direct bypass may offer superior long-term efficacy, although with a higher risk.
Keywords
References
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Submitted date:
12/18/2025
Accepted date:
12/29/2025
Publication date:
03/24/2026
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