Long-term Efficacy and Quality of Life Outcomes of 107 Revascularization Surgeries in Patients with Moyamoya Angiopathy: Findings from surgical population of GEN-O-MA Study

Background: Moyamoya angiopathy presents unique clinical characteristics in Western populations compared to Asian patients. Revascularization surgery remains the cornerstone of treatment, aimed at improving cerebral perfusion and reducing stroke risk. Aim: This study evaluates surgical outcomes in Italian adults and children with Moyamoya, enrolled in the GEN-O-MA project. Methods: A retrospective analysis of 107 procedures in 64 patients (53 adults, 11 children) was conducted between May and August 2024, using clinical and radiological evaluations. Complications, functional recovery, quality of life, bypass patency and cerebral perfusion were assessed during long-term follow-up. Results: In 32.2% of procedures, adults experienced mainly short-term postoperative symptoms. Surgical (2.3% of adult revascularizations; 10% of pediatric revascularizations) and late-onset (5.7% of adult revascularizations; 10% of pediatric revascularizations) complication rates were low in both adults and children, with children showing fewer issues during subsequent follow-ups. The overall postoperative course was favorable, with most new events being transient: at the 1-3- month follow-up, 8% of surgical procedures were associated with new events in the adult group, and 5% in the pediatric group; at the 6-month follow up, 2.3% in adults, none in children; at the 12-month follow-up, none in adults, 5% in children; and at the last follow-up, 10.3% in adults, with no new events in children. Functional recovery was more pronounced in pediatric patients, with significant improvement in mRS and KPS scores. Mental health and physical recovery were closely intertwined, with higher anxiety/depression scores correlating with new clinical events in adults (p-value: 0.043). Bypass patency rates remained high but variable (28.8% non- optimal), and CT perfusion confirmed improved cerebral blood flow post-surgery, especially in bilateral revascularizations. Conclusion: Revascularization surgery effectively improves long-term outcomes and quality of life in Western Moyamoya patients.