BACKGROUND:Existing studies comparing endoscopic and open approaches for isolated sagittal craniosynostosis are largely limited to single-institution studies or database studies that cannot control for suture type. This study applies new diagnostic ICD-10 codes that identify suture type to investigate differences between endoscopic and open surgical approaches for patients undergoing sagittal craniosynostosis repair. METHODS:Patients younger than 12 months old undergoing repair for isolated sagittal craniosynostosis were identified in the 2023 to 2024 National Surgical Quality Improvement Program (NSQIP) Pediatric database. Demographic characteristics, clinical comorbidities, and postoperative outcomes were compared between endoscopic and open repair cases. RESULTS:The final cohort included 693 patients, with an overall 30-day postoperative complication rate of 2.3%. After matching open and endoscopic cohorts for age, BMI, and ASA class, endoscopic repair was associated with lower blood transfusion rates (20.5% versus 37.9%, P=0.003) and fewer opioid prescriptions at discharge (21.2% versus 43.2%, P<0.001), though transfusion volumes did not differ when transfusions were given (P=0.23). Operative time (P=0.068), length of stay (P=0.093), and 30-day postoperative complication (P=0.72) and reoperation (P=1.00) rates did not differ significantly between propensity score-matched groups. CONCLUSIONS:In a novel, sagittal suture-specific analysis of a national surgical database, endoscopic and open repair of isolated sagittal craniosynostosis in infants younger than 12 months demonstrated comparable short-term perioperative safety. This analysis establishes a national benchmark for short-term outcomes in sagittal synostosis repair and demonstrates the methodological value of leveraging suture-specific ICD-10 coding in large-database craniosynostosis research.
Multiple symmetric lipomatosis can cause extraluminal upper-airway compression and aggravate obstructive sleep apnea (OSA). The authors report a 60-year-old man with severe OSA and marked anterior cervical lipomatosis who had persistent residual respiratory events despite adherent use of continuous positive airway pressure (CPAP) therapy. Anterior cervical lipectomy for neck contouring was performed, removing 2552 g of lipomatous tissue. Postoperatively, snoring improved and the device-reported residual apnea-hypopnea index decreased from 16.2 to 6.9 events/hours at 3 months and to 2.3 events/hours after CPAP reinitiation at 3 years 5 months. Anterior cervical lipectomy may improve CPAP responsiveness in selected patients with neck lipomatosis and prominent cervical airway compression.
BACKGROUND:A prominent premaxilla in bilateral cleft lip presents significant orthopedic and surgical challenges. Although presurgical infant orthopedics (PSIO) is widely used, evidence linking orthopedic response to clinically meaningful outcomes remains limited. This study evaluated orthopedic response, need for lip adhesion, and final aesthetic outcomes using blinded expert-panel assessments. METHODS:Fifty consecutive bilateral cleft patients treated with PSIO were reviewed, including 25 treated with nasal elevator and lip taping (NE) and 25 treated with Presurgical Lip-Alveolus-Nose Approximation (PLANA). Twenty-seven patients with prominent premaxilla underwent blinded assessment of orthopedic response by 3 cleft surgeons and 3 orthodontists. Final aesthetic outcomes were evaluated in a separate blinded assessment of 50 postoperative cases, mixing patients with and without prominent premaxilla to minimize recognition bias. RESULTS:The prevalence of prominent premaxilla was similar between groups (60.0% versus 48.0%; P=0.571). Lip adhesion was required more frequently in NE-treated than PLANA-treated patients (46.7% versus 8.3%; P=0.043). Patients treated with PLANA demonstrated superior orthopedic outcomes for premaxillary position, columellar length, and overall PSIO response (all P<0.001). Patients with prominent premaxilla achieved final nasal, lip, and overall nasolabial appearance ratings comparable to those without prominent premaxilla (all P>0.05). Evaluators showed poor ability to identify initially prominent premaxilla based on final appearance alone. Overall PSIO response correlated with final nasolabial appearance (ρ=0.48, P=0.024). CONCLUSIONS:Although a prominent premaxilla represents a more challenging initial deformity, it did not predict inferior final appearance. Better orthopedic response was associated with more favorable final aesthetic outcomes, supporting the clinical relevance of effective presurgical orthopedic correction.
This study aimed to compare the accuracy of maxillary repositioning using 2 types of CAD/CAM-fabricated splints (the traditional intermediate wafer and a customized maxillary repositioning guide) with a specific focus on dental interferences between the upper and lower arches during maxilla-first orthognathic surgery. Patients who exhibited dental interferences after maxillary movement during surgical simulation were enrolled. The intermediate wafer was designed to virtually open the patient's mandible, thereby avoiding tooth interference, whereas the guide was created independently of dental contacts. Accuracy was assessed by superimposing postoperative cone-beam computed tomography images onto preoperative virtual simulation data. Eighteen patients were included, with 13 in the guide group and 5 in the wafer group. The absolute error distance was larger in the wafer group for all landmarks. Errors exceeding 2 and 1 mm were more frequent in the wafer group than in the guide group (P=0.01 and 0.43, respectively). However, no significant differences were found between groups for three-dimensional error distances at each reference point, and no consistent error direction was observed. The customized maxillary repositioning guide demonstrated superior accuracy within the 2 mm discrepancy range compared with the intermediate wafer, especially in situations requiring mandibular position modification for intermediate wafer fabrication.
OBJECTIVE:Reconstruction of severe vertical and horizontal alveolar ridge defects remains a clinical challenge in implant dentistry. The Khoury bone plate technique is widely used; however, graft resorption and limited graft containment may affect outcomes. This study aimed to evaluate the clinical outcomes of the Composite Cortical Plate Grafting (CCPG) technique compared with the Khoury bone plate technique. This retrospective comparative clinical study included 64 ridge augmentation procedures performed using either a CCPG technique (n=32) or the Khoury bone plate technique (n=32). The dual-layer approach involved cortical plate fixation, composite grafting with autogenous bone and xenograft, followed by an additional xenograft layer and pericardium membrane coverage. Bone gain was assessed clinically and radiographically. Graft resorption was evaluated based on radiographic observations during follow-up. Implant success was defined by clinical stability and absence of complications. The follow-up period ranged from 6 to 12 months. RESULTS:The CCPG technique showed greater bone gain and improved graft stability compared with the Khoury technique. Lower graft resorption and higher implant placement success rates were observed in the CCPG group (93.7% versus 75%). Complication rates were lower in the CCPG group. CONCLUSIONS:The findings suggest that the CCPG technique may provide favorable outcomes in terms of bone gain and graft stability compared with the Khoury technique. This approach represents a modification of established ridge augmentation methods and may be considered in the management of complex alveolar defects.
Facial paralysis after craniocerebral surgery is a common postoperative complication that not only causes facial motor dysfunction but also triggers a series of psychosocial adaptation problems, severely affecting patients' quality of life. This paper systematically reviews recent domestic and international studies on the psychosocial adaptation of patients with postoperative facial paralysis. It explores the concept, current status, influencing factors, assessment tools, and interventions related to psychosocial adaptation. The purpose is to provide theoretical and practical references for clinical medical and nursing staff to implement targeted psychological guidance and intervention.
Secondary cleft palate reconstruction is challenging because residual or recurrent complications after palatoplasty occur in scarred, tissue-deficient, poorly vascularized fields, and buccal-based flaps are increasingly used for oronasal fistula (ONF) repair and for velopharyngeal dysfunction or insufficiency (VPD/VPI). This scoping review, conducted according to Joanna Briggs Institute methodology and reported following the PRISMA extension for scoping reviews, aimed to map current evidence on buccal-based flap applications in secondary cleft palate reconstruction, including indications, techniques, reported outcomes, complications, and evidence gaps. PubMed, Scopus, Web of Science, and Google Scholar were searched for clinical studies published from January 2021 to June 2026. Ten studies were included: 6 addressed VPD/VPI, 3 addressed ONF repair, and 1 addressed mixed indications. Buccal mucosal and buccinator myomucosal flaps were used for multilayer ONF closure, palatal lengthening, velopharyngeal augmentation, or as adjuncts to revision palatoplasty. Oronasal fistula outcomes varied substantially; VPD/VPI studies reported improvements in velopharyngeal closure and speech, but comparative cohorts did not consistently show significant between-group differences. Reporting of complications, donor-site morbidity, and airway outcomes was inconsistent. Buccal-based flaps may have clinical utility as context-dependent options, but current evidence is limited and insufficient to establish procedural superiority; the small number of heterogeneous, predominantly observational studies is itself the principal finding, defining a clear evidence gap. Prospective comparative studies with standardised outcomes, systematic donor-site and airway assessment, longer follow-up, and clearer patient-selection criteria are needed.
BACKGROUND:Neurofibromas are benign proliferations of Schwann cells, perineural cells, and endoneural fibroblasts. They are uncommon peripheral nerve sheath tumors that display a broad spectrum of histopathologic features. OBJECTIVES:To evaluate the clinical and histopathologic features of oral neurofibromas (ONs) diagnosed in the Oral Pathology Laboratory, College of Dentistry, the University of Baghdad (Baghdad, Iraq). STUDY DESIGN:A retrospective clinicopathologic study of ONs was performed (2010-2025). All cases were revised by 2 previously trained oral pathologists using light microscopy, and clinicopathologic data were collected. RESULTS:Demographic analysis revealed a high frequency of females (59.0%), with a mean age of 40.5 years. Four patients had NF-1 (n=4, 6.6%). The predominant clinical presentation consisted of asymptomatic masses, most frequently involving the gingiva (16.4%), buccal mucosa (14.8%), and palate (14.8%). Microscopically, the conventional neurofibroma subtype was most prevalent (65.6%), and the stroma was predominantly collagenous (62.3%), with significant mast cell infiltration (83.6%). Tumor size ranged from 0.4 to 8.0 cm, with lesions larger than 3.0 cm observed only in plexiform variants or recurrent tumors. The overall recurrence rate was 9.7%, mainly attributed to infiltrative growth patterns, including plexiform and diffuse morphologies. CONCLUSION:Oral neurofibromas are clinicopathologically heterogeneous. These neoplasms may occur as single or multiple lesions, with or without an association with neurofibromatosis type 1. Furthermore, the presence of mast cells and stromal maturation patterns is critical for accurate diagnosis. Neoplasms larger than 3 cm, or those with plexiform or diffuse growth patterns, should raise clinical suspicion for underlying syndromes.
The perception of facial appearance is shaped not only by objective anatomy but also by the observer's psychological and philosophical perspective. This editorial explores how the concepts of projection proposed by Freud, the broader understanding of projection and the Self developed by Jung, and a traditional saying attributed to the Korean Zen master Muhak offer complementary insights into aesthetic perception. Although arising from different intellectual traditions, these perspectives suggest that observers inevitably bring their own experiences, expectations, and states of mind to the interpretation of a face. Recognizing these influences may help plastic surgeons better understand patient expectations, body image, and the therapeutic relationship. Before asking how a face should be changed, surgeons may first ask through whose eyes that face is being seen.
AIM:To evaluate the aesthetic outcomes, patient satisfaction, and safety of chin augmentation using expanded polytetrafluoroethylene (ePTFE) implants over 12 months. METHODS:Of 152 patients who underwent intraoral ePTFE chin augmentation, 105 with complete 12-month follow-up were analyzed (85 women, 20 men; mean age 29.3 years; all with isolated microgenia and Angle Class I occlusion). The labiomental angle, chin projection, FACE-Q satisfaction score, and complications were assessed preoperatively and at 3, 6, and 12 months. Anthropometric variables were compared with the paired t test and FACE-Q scores with the Wilcoxon signed-rank test (STROBE-compliant). RESULTS:The labiomental angle decreased from 149.41±2.20 degrees to 130.92±2.51 degrees at 6 months (P<0.001) and was stable at 12 months. Chin projection improved from -3.78±0.61 mm to -0.82±0.53 mm (P<0.001), remaining stable. The FACE-Q satisfaction score improved from a preoperative median of 59 (interquartile range 55-65) to 88 (81-94) at 6 months (P<0.001) and was maintained at 12 months. Complications occurred in 14.3% (15/105), all minor and self-limiting (prolonged edema, transient lower-lip hypoaesthesia, and mild asymmetry); no infection, implant extrusion, or revision occurred. CONCLUSION:In this uncontrolled retrospective series, intraoral ePTFE chin augmentation was associated with significant, stable anthropometric improvement and a significant increase in patient satisfaction from baseline, with a low rate of minor complications. The absence of a control group precludes conclusions of superiority over other materials or techniques; comparative studies are warranted.
INTRODUCTION:Advanced tumors and trauma may cause composite oromandibular defects involving the mandible, intraoral mucosa, and skin. Although these defects involve multiple components, they can be reconstructed simultaneously with a single flap. The free fibula flap with chimeric skin paddles provides single-stage, appropriate three-dimensional reconstruction of challenging composite defects of the oromandibular region. The authors present our experience with free fibula flaps with chimeric skin paddles for composite oromandibular defects. METHODS:Between 2013 and 2023, 26 patients (20 male and 6 female) underwent reconstruction with free fibula flaps with chimeric skin paddles. Gunshot injury was the cause in 3 patients. Excision of squamous cell carcinoma (SCC) was the cause in the remaining 23 patients. Patients' ages ranged from 43 to 77 years. A two-team approach was used in all patients. RESULTS:The length of the fibular bone ranged from 5 cm to 13 cm. The width of the undivided fibular skin paddle ranged from 4 cm to 12 cm, and its length ranged from 8 cm to 23 cm. One hematoma and 2 cases of wound dehiscence occurred as nonvascular complications. In 1 patient, venous occlusion occurred on postoperative day 1. In this patient, necrosis of a single skin island occurred, but the second skin island and the bone were successfully salvaged. The remaining patients did not experience any vascular problems. CONCLUSION:The free fibula flap with chimeric skin paddles is a versatile and useful reconstructive option for complex composite oromandibular defects.
OBJECTIVE:To determine the association between detailed CT manifestations of nasal bone fracture and treatment strategy, emphasizing whether CT-derived structural severity can stratify conservative treatment, closed reduction, and open reduction/septorhinoplasty. METHODS:This retrospective imaging-based analysis included 80 patients with nasal bone fractures treated between January 2023 and May 2026. Thin-section CT indicators included maximum displacement, bony overlap, fracture laterality, fracture-line count, comminution, depressed segment, septal fracture, septal deviation angle, lateral nasal wall fracture, maxillary frontal process fracture, adjacent midface fracture, sinus opacification, soft-tissue swelling, and a composite CT severity score. The primary outcome was treatment strategy. Multivariable logistic regression was used to evaluate active reduction, and receiver operating characteristic analysis was used to assess the CT score. RESULTS:Conservative treatment was used in 19 patients, closed reduction in 41, and open reduction/septorhinoplasty in 20. Median CT severity score increased stepwise across these groups: 2, 5, and 9, respectively. Each 1-point increase in CT severity score was independently associated with active reduction [adjusted odds ratio, 1.50; 95% CI, (1.01, 2.24); P=0.047]. The CT score showed good discrimination for active reduction, with an area under the curve of 0.82. CONCLUSIONS:CT features reflecting bony instability, septal involvement, and adjacent midface extension were strongly aligned with treatment selection. A structured CT severity score may help standardize nasal fracture triage and clarify when to favor closed or open reduction.
Nonsurgical chin augmentation with hyaluronic acid (HA) fillers is a widely used technique in aesthetic medicine. However, outcomes may be influenced by hyperactivity of the mentalis muscle, which may lead to reduced longevity. Botulinum toxin type A (BoNT-A) may improve filler integration through myomodulation of muscles. To evaluate whether a combined protocol using BoNT-A followed by HA provides advantages over HA alone in nonsurgical chin augmentation in terms of aesthetic outcomes, HA volume required, longevity of results, and patient-reported pain. A retrospective study was conducted on 46 nonconsecutive patients treated between March 2022 and September 2024. All patients presented with chin retrusion assessed using the Galderma Chin Retrusion Scale (GCRS). Patients were divided into 2 groups: group 1 (n=23) received HA filler alone; group 2 (n=23) received a BoNT-A injection into the mentalis muscle, followed by an HA injection 10 to 15 days later. Follow-up was performed at 30 to 40 days and at 3, 6, 9, and 12 months. Both groups showed significant improvement in chin projection. The mean GCRS improved from 1.65 to 0.39 (Δ -1.26) in group 1 and from 1.83 to 0.35 (Δ -1.48) in group 2 (P>0.05). Group 2 required fewer HA touch-ups at 30 to 40 days (7 versus 14 patients). At 6 months, no patient in group 2 required HA reinjection, whereas 7 patients in group 1 required additional filler. Pain perception was lower in group 2. The combined BoNT-A and HA protocol appears to improve treatment stability and patient comfort in nonsurgical chin augmentation.
Adolf Hitler (1889-1945) presents one of the most thoroughly documented cases of progressive oral disease in modern European history, remarkable not only for its clinical severity but for the extraordinary forensic consequences to which that clinical condition gave rise. By the final year of his life, Hitler retained only 4 of his natural teeth; the remainder of his dentition had been replaced by an elaborate network of gold crowns, bridges, and prosthetic elements constructed and maintained by his personal dentist, Professor Hugo Johannes Blaschke (1881-1959), a graduate of the University of Pennsylvania who served simultaneously as chief of dental services for the Waffen-SS. The oral disease responsible for this near-total loss of natural dentition encompassed chronic periodontitis, rampant caries, and periapical sepsis, significantly compounded by poor oral hygiene, a high-sugar diet, and the xerogenic effects of the polypharmacy prescribed by Hitler's personal physician, Dr. Theodor Morell. When Hitler died by suicide in the Führerbunker on April 30, 1945, the unique and easily recognizable prosthetic work of Blaschke, recovered from among the charred remains in the Reich Chancellery garden, became the primary and ultimately definitive means of identifying his body. The forensic chain that followed involved his dental assistant, Käthe Heusermann; his dental prosthetist, Fritz Echtmann; the US Army Counter-Intelligence Corps interrogation of Blaschke in 1945 to 1946; the pioneering odontological identification by Sognnaes and Strøm in 1973; and the final confirmatory biomedical analysis by Charlier and colleagues in 2018.
INTRODUCTION:Anterior skull base (ASB) oncologic resection can create composite defects involving bone, dura, sinonasal cavities, orbit, and soft tissue. Although endoscopic techniques have expanded, open reconstruction remains essential for extensive tumors with intracranial, orbital, or craniofacial involvement. We systematically reviewed techniques and outcomes after open ASB reconstruction following oncologic resection. METHODS:Following PRISMA guidelines, PubMed, Embase, Cochrane Library, and Web of Science were searched through December 2025. Eligible studies included English-language original reports of patients undergoing oncologic tumor resection requiring open ASB reconstruction, with reported reconstructive technique and at least one clinical or surgical outcome. Data were extracted on study characteristics, surgical approach, flap or graft strategy, dural closure, structural support, adjuncts, and outcomes. Complications were categorized using a structured framework. RESULTS:Twenty-seven studies comprising 554 cases/procedures were included: 17 retrospective studies (13 cohorts and 4 case series) and 10 case reports. Tumor histologies were heterogeneous, with meningioma, esthesioneuroblastoma, and squamous cell carcinoma among the most frequently reported pathologies. Reconstruction strategies included pedicled regional flaps in 12 studies, free (microvascular) flaps in 7, non-vascularized free grafts in 4, a mixed local-and-free-flap strategy in 2, artificial dural grafts in 1, and an autologous fascia-muscle-fat composite in 1. Dural patch grafts were used in 18 studies, while watertight closure was explicitly reported in 12. Bone grafts were used in 12 studies, and titanium mesh in 7. Flap survival was reported in 20 studies, with 9 failures across the series. CSF leak was reported in 26 studies; 17 reported no leaks, while 9 documented leaks, with the highest cohort rate of 11.8%. Revision surgery was reported in 24 studies and occurred in 10. Complications included infectious, CSF-related, flap-related, and donor-site events. CONCLUSION:Open anterior skull base reconstruction has been reported as feasible across heterogeneous clinical series; however, the predominantly retrospective evidence does not support comparative conclusions regarding reconstructive superiority. Recurring practices included defect-specific multilayer closure, vascularized tissue coverage in compromised fields, and structural reconstruction when required.
Dirt-bike and trail-bike riding are increasingly popular recreational activities in the United States and are associated with a substantial risk of injury. Craniofacial trauma represents an important but understudied subset of these injuries, particularly given the potential for neurological, functional, and cosmetic consequences. This study aimed to characterize national patterns of craniofacial injuries associated with motorized dirt- and trail-bike accidents using data from the National Electronic Injury Surveillance System. A retrospective analysis was performed using NEISS data from 2015 to 2024. Cases involving 2-wheeled, powered off-road vehicles were identified using product code 5036, and craniofacial injuries were defined using body part codes corresponding to the head, face, eyeball, mouth, neck, and ear. An estimated 116,829 craniofacial injuries associated with off-road motorized bike use were identified during the study period. National injury estimates increased by ∼74.8% from 2015 to 2024. Head injuries accounted for the largest proportion of reportable body-part-specific estimates, followed by facial injuries. Adolescents aged 15 to 19 years accounted for the greatest proportion of injuries. Internal injury was the most frequently reported diagnosis across reportable age groups. Among cases with reportable age-stratified disposition estimates, most patients were treated and released, while a smaller proportion required hospital admission. These findings suggest that dirt and trail motorbike-related craniofacial injuries represent an increasing source of emergency department trauma and support continued surveillance of modifiable risk factors, including protective equipment use and riding conditions.
OBJECTIVES:The purpose of this study is to evaluate the incidence of locally recurrent midfacial tumors and the associated clinical features and risk factors. METHODS:This is a retrospective cohort study. Records of 327 midfacial tumor patients treated between 2010 and 2018 were reviewed. Clinical features and directions associated with local recurrence were analyzed. RESULTS:The study sample was composed of 327 subjects, and had a male-to-female ratio of 1.24:1. The median age was 57 years (range, 13-84 y). The median follow-up time was 28 months (range, 8-160 mo). The local recurrence rate for midfacial tumors was 32.8%, and was highest for sarcomas (55.9%), followed by ACCs (45.9%), SCCs (19.3%), and ameloblastomas (10.3%). The most frequent sites of recurrence were the superior aspect. SCC recurrence was associated with tumor size, cervical metastasis, and postoperative radiotherapy. ACC recurrence was associated with tumor size, primary site, and positive first margin. Ameloblastoma recurrence was associated with conservative surgery. CONCLUSION:Most frequent sites of local recurrence in midfacial neoplasms were the superior aspect. Midfacial tumor recurrence was associated with pathology, tumor size, primary site, positive margin, surgical method, or postoperative radiotherapy. LEVEL OF EVIDENCE:Level III-Retrospective comparative study.
Cleft lip and palate is the most common craniofacial anomaly. Primary repair occurs in the first year of life, with elective revision procedures becoming available in later childhood and adolescence. This study aims to evaluate the usability and acceptability of a decision aid designed to support shared decision-making for cleft-related revision surgery. This was accomplished with a mixed-method design at a single academic research setting. Participants included craniofacial surgeons, parents of children with cleft lip, and children with isolated cleft palate who were not actively considering revision surgery. Participants engaged with our decision aid while verbalizing feedback during think-aloud interviews. After completing all sections of the decision aid, participants completed the System Usability Scale, the Decision Aid Acceptability Scale, and the Single-Item Literacy Screener. Participants reported excellent usability. Acceptability scores indicated the decision aid was useful, unbiased, and appropriately informative. Qualitative analysis identified 3 key themes surrounding the importance of affirming and neutral language, improving visual appeal and usability, and clarifying realistic expectations regarding surgical outcomes. This is the first decision aid developed for cleft-related revision surgery. Feedback will inform refinements to optimize the language, visual aspects, and information included. Our findings support progression to beta testing and demonstrate potential for future integration into clinical practice as a tool that promotes shared decision-making for patients and families considering cleft revision procedures.
Isolated medial rectus palsy during endoscopic sinus surgery is an embarrassing event for surgeons and often results in persistent diplopia despite corrective surgery; therefore, its cause should be identified immediately. Because direct traumatic injury to the medial rectus always accompanies tearing of the periorbita and exposure of the orbital fat, other causes should be considered when no direct orbital injury is evident. Here, the authors report a case of local-anesthetic-induced transient isolated medial rectus palsy that recovered spontaneously after surgery.
BACKGROUND:Moyamoya disease (MMD) is a chronic progressive cerebrovascular disease characterized by bilateral steno-occlusive changes at the terminal internal carotid arteries. Fragile vascular wall alterations combined with hemodynamic stress may facilitate intracranial aneurysm formation. This study aimed to identify risk factors of intracranial hemorrhage in MMD patients with associated aneurysms. METHODS:Between March 2014 and October 2021, a consecutive cohort of 69 patients who were diagnosed with MMD associated with aneurysms was enrolled in this retrospective single-center study. Treatments, including conservation, endovascular intervention, surgical clipping, and revascularization, were conducted in patients based on individual status and clinical experience. Hemorrhage was noticed by annual clinical visit or telephone and confirmed by computed tomography. RESULTS:This cohort of MMD with IA underwent a median follow-up of 76.2 months. During this period, 17 patients experienced hemorrhage while 52 maintained hemorrhagic-free survival. Logistic regression showed that ipsilateral moyamoya vessels with aneurysms (P=0.018) and low admission GCS (P<0.001) were independent predictors of hemorrhage. Cox regression analysis also confirmed both factors (P=0.003; <0.001) had a statistical association with reduced hemorrhage-free survival. No significant differences between the nonhemorrhagic and hemorrhagic groups were observed in sex, age, previous hemorrhage, or impaired perfusion on computed tomography perfusion between the 2 groups. CONCLUSIONS:Hemorrhage constituted a clinically significant incident in MMD with aneurysm, characterized by relatively high frequency and catastrophic neurological consequences. Ipsilateral moyamoya vessels harboring aneurysms and low admission GCS were independent factors for hemorrhage following initial intervention. Both factors also correlated with shorter hemorrhage-free survival.
