{
  "abstract": "Background Bilateral ischemic manifestations in Moyamoya disease (MMD) pose substantial therapeutic challenges, particularly in cases characterized by heterogeneous cerebrovascular involvement where one hemisphere presents with complete occlusion while the contralateral side exhibits severe stenosis. Contemporary treatment paradigms frequently prove inadequate in addressing this complex clinical scenario, often failing to achieve optimal revascularization outcomes and long-term symptom management.Objective To perform a preliminary evaluation of the efficacy and safety of a hybrid surgical strategy in adults with bilateral ischemic MMD.Methods Eight adult patients (mean age 39±12.2 years) were treated. The occluded hemisphere underwent direct/combined bypass, while the stenotic side received endovascular balloon angioplasty. Perioperative imaging (CT/MR/ultrasound) and clinical/magnetic resonance angiography (MRA) follow-ups were performed.Results The surgical success rate was 100%. One patient required emergency stenting for an acute dissection post-angioplasty but recovered well. No other perioperative infarctions occurred (one case of delayed occlusion on the expanded side with new infarction). During follow-up, one patient developed ischemic symptoms with stenosis progression on the angioplasty side, necessitating subsequent bypass. The remaining six patients remained symptom-free. Postoperative digital subtraction angiography (DSA) in four patients confirmed excellent revascularization (Grade A/B) without worsening stenosis.Conclusion A hybrid surgical approach combining bypass surgery and balloon angioplasty may offer a viable treatment option for bilateral MMD.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Yunyu Wen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Tinghan Long"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Junda Chen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Fangzhou Chen"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Yucheng Wang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Siyuan Chen"
    },
    {
      "affiliations": [
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Xiaonian Chai"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Guozhong Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Mingzhou Li"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Shichao Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Huibin Kang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Peng Li"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Wenfeng Feng"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Laboratory for Precision Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China",
        "Southern Medical University, Guangzhou, Guangdong, China"
      ],
      "name": "Gang Wang"
    }
  ],
  "title": "Hybrid surgical and endovascular approach for bilateral symptomatic moyamoya disease: a single-center preliminary experience",
  "uid": "133a990d-a048-546a-adfe-b2534f557c12"
}