Association Between Preexisting Thyroid Disorders and Immediate Postoperative Neurological Complications After STA-MCA Bypass in Adult Moyamoya Angiopathy: A Single-Center Retrospective Cohort Study from Italy.

Abstract

Postoperative neurological complications remain a relevant concern after superficial temporal artery-middle cerebral artery (STA-MCA) bypass in patients with moyamoya disease. While disease-related factors have been widely studied, the impact of preexisting medical conditions on immediate postoperative outcomes is less clear. To evaluate whether previous diseases, chronic conditions, and psychiatric disorders are associated with postoperative neurological complications after STA-MCA bypass in adult moyamoya patients. We conducted a retrospective analysis of consecutive adult patients undergoing STA-MCA bypass at the Istituto Neurologico Carlo Besta between 2005 and 2023. Demographic variables and comorbidities were analyzed. The primary outcome was postoperative neurological complications during the in-hospital period. Group comparisons were performed using Mann-Whitney U and chi-square tests. A Firth logistic regression model was used to identify independent predictors. Fifty-three patients were included, of whom 12 (23%) developed postoperative neurological complications. Thyroid disorders were present in 11 patients (21%) and were significantly associated with complications (46% vs 17%, p=0.042). No other comorbidities showed significant associations. In Firth regression analysis, thyroid disorder remained associated with complications (OR 5.15, p=0.040), while age showed a modest effect (OR 1.05, p=0.004). In our single-center experience, preexisting thyroid disorders were associated with a higher frequency of immediate postoperative neurological complications after STA-MCA bypass. Given the retrospective design and limited sample size, these findings should be considered exploratory and hypothesis-generating. Further studies are needed to validate this association.