Two‐Piece Craniotomy Is Associated With Improved Postoperative Outcomes of Combined Revascularization in Patients With Moyamoya Disease

Background Revascularization for both anterior cerebral artery (ACA) and middle (MCA) territories in patients with moyamoya disease is often performed a single operation. The influence of craniotomy type on postoperative outcomes has not been investigated. This study aimed to clarify the effects acute after combined revascularization by comparing 2‐piece, large 1‐piece approaches. Methods retrospective included 337 consecutive revascularizations ACA MCA disease. Surgeries were classified into 2‐piece groups. For indirect bypass, following methods used: (1) encephalo‐myo‐galeo‐periosteal‐synangiosis territories; (2) encephalo‐myo‐synangiosis territory encephalo‐periosteal‐synangiosis territory. Acute compared between Results Two‐piece craniotomies 230 107 patients, respectively. incidence radiological symptomatic infarction tended be lower group than that (3.9% versus 11.2%; P =0.014, 2.6% 6.5%; =0.12, respectively). Logistic regression adjusted potential confounders further explained relationship (large 1‐piece/2‐piece craniotomy: odds ratio, 3.1; 95% CI, 1.2–7.6; =0.015). Conclusion In disease, may reduce risk infarction.