Evidence map›Paper›PMID 42026373›Full record

Observational studyChild's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery2026

Safety and long-term outcomes following bypass surgery in pediatric versus adult patients with Moyamoya disease: a multicenter cohort study.

Victor Gabriel El-Hajj, Joanna M Roy, Basel Musmar, Kareem El Naamani, Keenan Piper, Valid Rastegar, Wi Jin Kim, Nathaniel Ellens, Michael Rizzuto, Rabab Alshahrani and 34 more

Abstract readComparative StudyMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

44 authors.

Victor Gabriel El-HajjDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Joanna M RoyDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Basel MusmarDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Kareem El NaamaniDepartment of Neurosurgery, University of Arizona College Of Medicine, Tucson, AZ, USA.
Keenan PiperDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Valid RastegarDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Wi Jin KimDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Nathaniel EllensDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Michael RizzutoDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Rabab AlshahraniTrillium Health Partners, 100 Queensway West, Mississauga, Ontario, L5B 1B8, Canada.
Ching-Jen ChenDepartment of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA.
Roland JabreDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Hassan SaadDepartment of Neurosurgery, Emory University, Atlanta, GA, USA.
Jonathan A GrossbergDepartment of Neurosurgery, Emory University, Atlanta, GA, USA.
Adam A DmytriwDepartment of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Aman B PatelNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Mirhojjat KhorasanizadehDepartment of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Christopher S OgilvyDepartment of Neurosurgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Ajith J ThomasDepartment of Neurological Surgery, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, NJ, USA.
Andre MonteiroDepartment of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA.
Adnan SiddiquiDepartment of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA.
Atakan OrscelikDepartment of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
Luis SavastanoDepartment of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
Gustavo M CortezLyerly Neurosurgery, Baptist Health System, Jacksonville, Jacksonville, FL, USA.
Ricardo A HanelLyerly Neurosurgery, Baptist Health System, Jacksonville, Jacksonville, FL, USA.
Guilherme PortoDepartment of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Alejandro M SpiottaDepartment of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, Charleston, SC, USA.
Anthony J PiscopoDepartment of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA.
David M HasanDepartment of Neurosurgery, Duke University, Durham, NC, USA.
Mohammad GhorbaniDepartment of Neurosurgery, Firoozgar Hospital, Tehran, Iran.
Joshua WeinbergDepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Shahid M NimjeeDepartment of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Kimon BekelisGood Samaritan Hospital Medical Center, Babylon, NY, USA.
Mohamed M SalemDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA.
Jan-Karl BurkhardtDepartment of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, PA, USA.
Akli ZetchiDepartment of Neurosurgery, Yale University, New Haven, CT, USA.
Charles MatoukDepartment of Neurosurgery, Yale University, New Haven, CT, USA.
Brian M HowardDepartment of Neurosurgery, Emory University, Atlanta, GA, USA.
Rosalind LaiDepartment of Neurosurgery, University of New York at Buffalo, Buffalo, NY, USA.
Rose DuNeuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Stavropoula I TjoumakarisDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Michael Reid GoochDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Robert H RosenwasserDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Pascal JabbourDepartment of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. pascal.jabbour@jefferson.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveMoyamoya disease (MMD) is a progressive cerebrovascular disorder and an important cause of childhood stroke. Surgical revascularization is the established treatment for symptomatic disease. However, comparative data examining perioperative safety and long-term outcomes between pediatric and adult patients remain limited. This study hence aimed to evaluate whether age influences postoperative complications, early neurological outcomes, and long-term stroke risk following direct and/or indirect bypass surgery.

methodsWe conducted a retrospective multicenter cohort study of patients with MMD who underwent surgical revascularization at 13 academic centers across North America between 2008 and 2022. The primary outcomes were overall postoperative complications and long-term stroke occurrence. Comparisons between pediatric (≤ 18 years) and adult (> 18 years) hemispheres were performed using overlap propensity score weighting (PSW) to adjust for differences in baseline characteristics. Sensitivity analyses were conducted in patients with ≥ 2 years of follow-up.

resultsA total of 567 hemispheres (523 adult, 44 pediatric) were included. Adults had higher rates of vascular comorbidities, whereas pediatric patients more frequently presented with congenital conditions and earlier Suzuki grades. Pre- and post-PSW analyses demonstrated no significant age-related differences in outcomes (p ≥ 0.05). On weighted regression, age was not associated with postoperative complications (OR 0.92; 95% CI 0.41-2.05), discharge neurological status (mRS: OR 1.08; 95% CI 0.52-2.21; and NIHSS: OR 0.97; 95% CI 0.45-2.10), or long-term cerebrovascular events (OR 0.88; 95% CI 0.28-2.74). On sensitivity analysis of patients with > 2 years of follow-up, no pediatric hemispheres experienced stroke compared with 12% of adult hemispheres, though this difference was not statistically significant (p = 0.14).

conclusionsDespite marked differences in baseline comorbidities and angiographic severity, pediatric and adult patients experienced similar perioperative outcomes and long-term stroke risk after bypass surgery. These findings support the durability and safety of both direct and indirect revascularization across age groups.

Indexed as

Cerebral RevascularizationMoyamoya DiseasePostoperative ComplicationsAdolescentAdultAge FactorsChildChild, PreschoolCohort StudiesFemaleHumansMaleMiddle AgedRetrospective StudiesStrokeTreatment OutcomeAdultBypassMoyamoya diseasePediatricRevascularization surgeryStroke

Identifiers

PMID42026373

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.