Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults. J 394. Li Q, Gao Y, Xin W, Zhou Z, Rong H, Qin Y, Li K, Zhou Y, Wang J, Xiong J, et al. Meta-analysis of prognosis of different treatments for symptom- atic moyamoya disease. World Neurosurg. 2019;127:354 361. doi: 395. Sun H, Wilson C, Ozpinar A, Safavi-Abbasi S, Zhao Y, Nakaji P, Wanebo JE, Spetzler RF. Perioperative complications and long-term outcomes after bypasses in adults with moyamoya disease: a systematic re- view and meta-analysis. World Neurosurg. 2016;92:179 188. doi: 396. Kim H, Jang DK, Han YM, Sung JH, Park IS, Lee KS, Yang JH, Huh PW, Park YS, Kim DS, et al. Direct bypass versus indirect bypass in adult moy- amoya angiopathy with symptoms or hemodynamic instability: a meta- analysis of comparative studies. World Neurosurg. 2016;94:273 284. doi: 397. Jang DK, Lee KS, Rha HK, Huh PW, Yang JH, Park IS, Ahn JG, Sung JH, Han YM. Bypass surgery versus medical treatment for symptom- atic moyamoya disease in adults. J Neurosurg. 2017;127:492 502. doi: 398. Yamada S, Oki K, Itoh Y, Kuroda S, Houkin K, Tominaga T, Miyamoto S, Hashimoto N, Suzuki N; Research Committee on Spontaneous Occlusion of Circle of Willis (Moyamoya Disease). Effects of surgery and antiplate- let therapy in ten-year follow-up from the registry study of Research Committee on Moyamoya Disease in Japan. J Stroke Cerebrovasc Dis. CLINICAL STATEMENTS AND GUIDELINES Kleindorfer 399. Qian C, Yu X, Li J, Chen J, Wang L, Chen G. The efficacy of surgical treat- ment for the secondary prevention of stroke in symptomatic moyamoya disease: a meta-analysis. Medicine (Baltimore). 2015;94:e2218. doi: 400. Onozuka D, Hagihara A, Nishimura K, Kada A, Nakagawara J, Ogasawara K, Ono J, Shiokawa Y, Aruga T, Miyachi S, et al; J-ASPECT Study Collaborators. 