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Background: Moyamoya disease (MMD) is a rare cerebrovascular disorder marked by internal carotid artery narrowing, collateral neovascularization, and symptomatic cerebral ischemia. Select patients can benefit from direct bypass (superficial temporal artery [STA]-proximal middle [MCA] bypass) by restoring blood flow to hypoperfused territories. Symptomatic contralateral stroke (CS) following STA-MCA bypass is a devastating, poorly understood complication. We investigate clinical and radiographic risk factors influencing CS incidence after bypass surgery., Methods: A retrospective review of patients with bilateral MMD undergoing STA-MCA bypass at our institution (2018-2022) included demographic details, comorbidities, average preoperative systolic blood pressure (SBP), postoperative SBP goals, and angiographic patterns. Preoperative diagnostic angiograms were analyzed for collateral vascular patterns. Postoperative clinical course was recorded. Statistical analyses employed parametric and nonparametric tests for small sample size., Results: Six of 39 patients (15.4%) experienced CS postbypass. No baseline demographic differences were identified between patients with and without CS. CS patients had higher preoperative SBP (146.2 vs. 131.1, P < 0.05), were more likely to have postoperative SBP goals below their average preoperative SBP (66.7% vs. 15.2%, P = 0.018) and had longer time from symptom onset to surgery (51.8 vs. 13 months, P = 0.039). There were no differences in specific angiographic patterns in either hemisphere for patients with CS versus those without CS though overall contralateral Suzuki grade was higher in patients with CS (P < 0.05)., Conclusions: Patients with CS following bypass had significantly higher preoperative SBP, postoperative SBP goals below their average preoperative SBP, and longer time from symptom onset to surgery compared to patients without CS. Patient-specific postoperative SBP management and timely surgical revascularization are crucial for preventing CS in patients with MMD undergoing STA-MCA bypass., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: To identify LGBTQ+ diversity, equity, and inclusion (DEI) publications and contextualize the current frequency of the literature across subspecialty surgical fields., Methods: A PRISMA systematic review using PubMed, MEDLINE, and Web of Science was conducted in April 2024. The main inclusion criterion was intrafield DEI content for defined subspecialties; exclusion criteria were foreign language, poor methodology, and duplicates. The primary endpoint was the number of publications across subspecialties. Secondary endpoints included publication dates, study design, and sample size., Results: Of the 702 articles identified, 27 were included in the analysis. Neurologic surgery had 2 studies; plastic surgery, 11 studies; orthopedic surgery, 7 studies; otolaryngology, 5 studies; and thoracic surgery, 2 studies. There was a statistically significant different frequency of publications across subspecialties (P = 0.031). Post hoc residual analysis indicated that neurosurgery and thoracic surgery had statistically fewer publications, while plastic surgery had statistically more publications (P = 0.04, 0.002, 0.21, 0.42, and 0.04 for neurologic surgery, plastic surgery, orthopedic surgery, otolaryngology, and thoracic surgery, respectively). Secondary outcomes found a majority of publications between 2022 and 2024. Study methodologies involved cross-sectional studies, editorials, and retrospective reviews (14, 11, and 3 respectively) and had a median sample size of 248.5., Conclusions: This systematic review provides objective data to contextualize DEI literature across surgical subspecialties. Overall, this review highlights the lack of LGBTQ+ DEI literature in neurosurgery and advocates for correcting this gap for the benefit of both surgeons and patients. Understanding the current numbers and evaluating progress in other surgical fields might provide solutions., (Copyright © 2024 Elsevier Inc. All rights reserved.)