Standardized Occipital Artery–Posterior Cerebral Artery Bypass With Encephalo-Duro-Pericranial Synangiosis Using a Cortical P4 Recipient for Posterior Circulation–Involved Moyamoya Disease
Ying Huang, Jia-Yi Chang, Zeng-Wei Feng, Yun-Long Zuo, Fu-Xing Zuo, Li-Ping Yu, Ling Xue, Guo-Qiang Chen, Hong-Yan Han, Satoshi KurodaBACKGROUND AND OBJECTIVES:
Posterior cerebral artery involvement in moyamoya disease (MMD) is associated with occipital hypoperfusion, visual disturbance, recurrent ischemic events, and worse neurological status. In selected patients, posterior circulation–targeted revascularization may represent an important component of surgical management. We evaluated outcomes after a standardized occipital artery–posterior cerebral artery (OA–PCA) bypass strategy using a cortical P4 recipient combined with encephalo-duro-pericranial synangiosis (EDPS) in patients with posterior circulation–involved MMD.
METHODS:
We retrospectively reviewed consecutive posterior circulation revascularization procedures performed from August 2012 through December 2024. All procedures used a standardized OA–PCA bypass to a cortical P4 recipient combined with EDPS. The primary outcome was bypass patency on follow-up imaging. Secondary outcomes included collateral formation, perfusion improvement, early visual improvement, modified Rankin Scale improvement, and procedure-related perioperative adverse events.
RESULTS:
A total of 113 procedures in 109 patients were included. Early postoperative computed tomography angiography confirmed bypass patency in all evaluable procedures (112/112, 100%). At 12 months or later, bypass patency was observed in 59 of 102 procedures (57.8%), collateral formation in 63 of 102 procedures (61.8%, grades A-B), and perfusion improvement in 63 of 102 procedures (61.8%). Among 72 procedures with documented preoperative visual disturbance, early visual improvement occurred in 31 (43.1%). Modified Rankin Scale improvement of at least 1 point at last follow-up occurred in 69 of 113 procedures (61.1%). Procedure-related perioperative adverse events were infrequent, and no bypass-related reoperation occurred within 30 days.
CONCLUSION:
In this single-center retrospective series, standardized OA–PCA bypass using a cortical P4 recipient combined with EDPS was associated with reliable early graft patency and favorable angiographic, perfusion, and clinical outcomes in selected patients with posterior circulation–involved MMD. Late graft status should be interpreted together with collateral development, perfusion findings, and clinical course rather than in isolation.