Treatment Options for Patients With Moyamoya Disease: A Retrospective Cohort Study.

PURPOSE: Surgical revascularization is the preferred treatment for most patients with Moyamoya disease (MMD). Nevertheless, a considerable number of eligible patients choose non-surgical management. This study aimed to identify factors influencing treatment decisions, with particular emphasis on asymptomatic MMD patients. MATERIALS AND METHODS: We conducted a retrospective analysis of MMD patients without surgical contraindications treated at our center between 2010 and 2022. Baseline characteristics were compared using Wilcoxon rank-sum and chi-squared tests. Multivariable logistic regression was used to identify factors associated with treatment selection. RESULTS: Among the 147 included patients, 62.6% underwent surgical treatment. Younger age (OR = 0.88, 95% CI: 0.88-0.94, p < 0.001), married status (OR = 653.3, 95% CI: 41.61-10,264.22, p < 0.001), and absence of hyperlipidemia (OR = 0.16, 95% CI: 0.03-0.85, p < 0.05) were significantly associated with choosing surgery. Asymptomatic patients underwent surgery at a higher rate than symptomatic patients (67.9% vs. 59.6%). Younger age was a significant predictor of surgical preference in both symptomatic and asymptomatic subgroups. CONCLUSION: Younger age is strongly associated with the choice of surgical treatment in MMD, including in asymptomatic cases.