Surgical revascularization (RV) methods for moyamoya disease (MMD) can be categorized into three groups: direct, indirect, and combined RV procedures. Selection of the procedure depends on the age of the patient, anatomic size of the donor/recipient vessels, preoperative extent of compromised hemodynamics (cerebral blood flow, CBF, and vascular reserve), and surgeon's preference. A report by the Japanese Ministry of Health and Welfare (1997) revealed that, of 302 patients with moyamoya disease (MMD), 162 (53.6%) patients received indirect bypass surgery, 35 (11.6%) received direct bypass surgery, 50 (16.6%) received combined indirect and direct bypass surgery, and 55 (18.2%) patients had no surgical treatment [1].


Anterior Cerebral Artery Moyamoya Disease Oxygen Extraction Fraction Direct Procedure Indirect Procedure 
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  1. 1.
    Yoshida YK, Shirane R (2001) Indirect bypass procedure. In: Ikezaki K, Loftus CM (eds) Moyamoya disease. AANS Publication Committee, Rolling MeadowsGoogle Scholar
  2. 2.
    Fung LW, Thompson D, Ganesan V (2005) Revascularization surgery for pediatric moyamoya: a review of the literature. Childs Nerv Syst 21:358–364PubMedCrossRefGoogle Scholar
  3. 3.
    Karasawa J, Touho H, Ohnishi H et al (1992) Long-term follow-up study after extracranial-intracra-nial bypass surgery for anterior circulation ischemia in childhood moyamoya disease. J Neurosurg 77:84–89PubMedCrossRefGoogle Scholar
  4. 4.
    Suzuki Y, Negoro M, Shibuya M et al (1997) Surgical treatment for pediatric moyamoya disease: use of the superficial temporal artery for both areas supplied by the anterior and middle cerebral arteries. Neurosurgery 40:324–330PubMedCrossRefGoogle Scholar
  5. 5.
    Houkin K, Ishikawa T, Yoshimoto T et al (1997) Direct and indirect revascularization for moyamoya disease surgical techniques and peri-operative complications. Clin Neurol Neurosurg 99:S142–S145PubMedGoogle Scholar
  6. 6.
    Golby AJ, Marks MP, Thompson RC et al (1999) Direct and combined revascularization in pediatric moyamoya disease. Neurosurgery 45:50–60PubMedCrossRefGoogle Scholar
  7. 7.
    Guzman R, Lee M, Achrol A et al (2009) Clinical outcome after 450 revascularization procedures for moymoy disease. J Neurosurg, doi: 10.3171/2009.4.JNS081649Google Scholar
  8. 8.
    Scott RM (1997) Comments in article of Suzuki Y. et al [4]Google Scholar
  9. 9.
    Isono M, Ishii K, Kamida T et al (2002) Long-term outcomes of pediatric moyamoya disease treated by encephalo-duro-arterio-synangiosis (EDAS). Pediatr Neurosurg 36:14–21PubMedCrossRefGoogle Scholar
  10. 10.
    Starke RM, Komotar RJ, Hickman ZL et al (2009) Clinical features, surgical treatment, and long-term outcome in adult patients with moyamoya disease. J Neurosurg, DOI: 10.3171/2009.3.JNS08837Google Scholar
  11. 11.
    Fujimura M, Kaneta T, Mugikura S et al (2007) Temporary neurologic deterioration due to cerebral hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in patients with adult-onset moyamoya disease. Surg Neurol 67(3):273–282PubMedCrossRefGoogle Scholar
  12. 12.
    Kim JE, Oh CW, Kwon OK et al (2008) Transient hyperperfusion after superficial temporal artery/ middle cerebral artery bypass as a possible cause of postoperative transient neurological deterioration. Cerebrovasc Dis 25:580–586PubMedCrossRefGoogle Scholar
  13. 13.
    Veeravagu A, Guzman R, Path CG et al (2008) Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions. Neurosurg Focus 24(2):1–9CrossRefGoogle Scholar
  14. 14.
    Matsushima T, Inoue T, Suzuki SO et al (1992) Surgical treatment of moyamoya disease in pediatric patients-comparison the results of indirect and direct revascularization procedures. Neurosurgery 31:401–405PubMedCrossRefGoogle Scholar
  15. 15.
    Ishikawa T, Houkin K, Kamiyama H et al (1997) Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease. Stroke 27:1170–1173CrossRefGoogle Scholar
  16. 16.
    Houkin K, Kuroda S, Ishikawa T et al (2000) Neovascularization(Angiogenesis) after revasculariza-tion in moyamoya disease. Which technique is most useful for moyamoya disease? Acta Neurochir (Wien) 142:269–276CrossRefGoogle Scholar
  17. 17.
    Kim DS, Kang SG, Yoo DS et al (2007) Surgical results in pediatric moyamoya disease: Angiographic revascularization and clinical results. Clin Neurol Neurosurg 109:125–131PubMedCrossRefGoogle Scholar
  18. 18.
    Han DH, Nam DH, Oh CW (1997) Moyamoya disease in adults: characteristics of clinical presentation and outcome after encephalo-duro-arterio-synangiosis. Clin Neurol Neurosurg 99(Suppl 2): S151–S155PubMedGoogle Scholar
  19. 19.
    Matsushima Y, Fukai N, Tanaka K et al (1981) A new surgical treatment of moyamoya disease in children: a preliminary report. Surg Neurol 15:313–320PubMedCrossRefGoogle Scholar
  20. 20.
    Kinugasa K, Mandai S, Kamata I et al (1993) Surgical treatment of moyamoya disease: operative technique for encephalo-duro-arterio-myo-synangiosis, its follow-up, clinical results, and angio-grams. Neurosurgery 50:88–96Google Scholar
  21. 21.
    Ikezaki K (2000) Rational approach to treatment of moyamoya disease in childhood. J Child Neurol 15:350–356PubMedCrossRefGoogle Scholar
  22. 22.
    Karasawa J, Kikudhi H, Furuse S et al (1977) A surgical treatment of “moyamoya ” disease “encephalo-myo-synangiosis ”. Neurol Med Chir 17:29–37CrossRefGoogle Scholar
  23. 23.
    Kim SK, Wang KC, Kim IO et al (2002) Combined encephaloduroarteriosynangiosis and bifrontal encephalogaleo(periosteal)synangiosis in pediatric moyamoya disease. Neurosurgery 50:88–96PubMedGoogle Scholar
  24. 24.
    Matsushima T, Inoue T, Katsuta T et al (1998) An indirect revascularization method in the surgical treatment of moyamoya disease: various kinds of indirect procedure and a multiple combined indirect procedure. Neurol Med Chir(Tokyo) 38(Suppl):297–302CrossRefGoogle Scholar
  25. 25.
    Ishikawa T, Kamiyama H, Kuroda S et al (2006) Simultaneous superficial temporal artery to middle cerebral or anterior cerebral bypass with pan-synangiosis for moyamoya disease covering both anterior and middle cerebral artery territories. Technical note. Neurol Med Chir(Tokyo) 46:462–468CrossRefGoogle Scholar
  26. 26.
    Scott RM (2000) Moyamoya syndrome: a surgically treatable cause of stroke in pediatric patient. Clin Neurosurg 47:378–384PubMedGoogle Scholar
  27. 27.
    Mizoi K, Kayama T, Yoshimoto T et al (1996) Indirect revascularization for moyamoya disease: is there a beneficial effect for adult patients? Surg Neurol 45:541–549PubMedCrossRefGoogle Scholar
  28. 28.
    Kinugasa K, Mandai S, Tokunaga K et al (1994) Ribbon encephalo-duro-arterio-myo-synangiosis for moyamoya disease. Surg Neurol 41:455–461PubMedCrossRefGoogle Scholar
  29. 29.
    Nakashima H, Meguro T, Kawada S et al (1997) Long-term results of surgically treated moyamoya disease. Clin Neurol Neurosurg 99(Suppl 2):156–161Google Scholar
  30. 30.
    Tenjin H, Ueda S (1997) Multiple EDAS, additional EDAS using the frontal branch of the STA and the occipital artery for pediatric moyamoya patients in whom EDAS using the parietal branch of STA was insufficient. Child's Nerv Syst 13:220–224CrossRefGoogle Scholar
  31. 31.
    Sainte-Rose C, Oliveira R, Puget S et al (2006) Multiple bur hole surgery for the treatment of moy-amoya disease in children. J Neurosurg 105(Suppl 6):437–443PubMedGoogle Scholar
  32. 32.
    Braun KPJ, Bulder MMM, Chabrier S et al (2009) The course and outcome of unilateral intracranial arteriopathy in 79 children with ischemic stroke. Brain 132:544–557PubMedCrossRefGoogle Scholar
  33. 33.
    Kelly ME, Bell-Stephens TE, Mark MP et al (2006) Progression of unilateral moyamoya disease: A clinical series. Cerebrov Dis 22:109–115CrossRefGoogle Scholar
  34. 34.
    Narisawa A, Fujimura M, Tominaga T (2009) Efficacy of the revascularization surgery for adult-onset moyamoya disease with the progression of cerebrovascular lesions. Clin Neurol Neurosurg 111(2):123–126PubMedCrossRefGoogle Scholar
  35. 35.
    Matsushima Y, Aoyagi M, Masaoka H et al (1990) Mental outcome following encephaloduroarterio-synangiosis in children with moyamoya disease with the onset earlier than 5 years of age. Childs Nerv Syst 6(8):440–443PubMedCrossRefGoogle Scholar
  36. 36.
    Nagata S, Matsushima T, Morioka T et al (2006) Unilaterally symptomatic moyamoya disease in children: long-term following of 20 patients. Neurosurgery 59(4):830–836PubMedCrossRefGoogle Scholar
  37. 37.
    Kim SK, Seol HJ, Cho BK et al (2004) Moyamoya disease among young patients: its aggressive clinical course and the role of active surgical treatment. Neurosurgery 54:840–844; discussion 844–846PubMedCrossRefGoogle Scholar
  38. 38.
    Ogawa A, Yoshimoto T, Suzuki J et al (1990) Cerebral blood flow in moyamoya disease Part 1: Correlation with age and regional distribution. Acta Neurochir (Wien) 105:30–34CrossRefGoogle Scholar
  39. 39.
    Ikezaki K, Matsushima T, Kuwabara Y et al (1994) Cerebral circulation and oxygen metabolism in childhood moyamoya disease: a perioperative positron emission tomography study. J Neurosurg 81:843–850PubMedCrossRefGoogle Scholar
  40. 40.
    Kuroda S, Houkin K, Ishikawa T et al (2004) Determinants of intellectual outcome after surgical revascularization in pediatric moyamoya disease: a multivariate analysis. Childs Nerv Syst 20(5):302–308PubMedCrossRefGoogle Scholar
  41. 41.
    Fujita K, Tamaki N, Matsumoto S (1986) Surgical treatment of moyamoya disease in children: which is more effective procedure, EDAS or EMS? Childs Nerv Syst 2:134–138PubMedCrossRefGoogle Scholar
  42. 42.
    Nariai T, Suzuki R, Matsushima Y et al (1994) Surgically induced angiogenesis to compensate for hemodynamic cerebral ischemia. Stroke 25:1014–1021PubMedCrossRefGoogle Scholar
  43. 43.
    Kuroda S, Houkin K (2008) Moyamoya disease: current concepts and future prospective. Lancet Neurol 7:1056–1066PubMedCrossRefGoogle Scholar
  44. 44.
    Miyamoto S, Akiyama Y, Nagata I et al (1998) Long-term outcome after STA–MCA anastomosis for moyamoya disease. Neurosurg Focus 5(5):Article 5Google Scholar
  45. 45.
    Scott RM, Smith JL, Robertson RL et al (2004) Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg 100(2 Suppl Pediatrics):142–149PubMedGoogle Scholar

Copyright information

© Springer 2010

Authors and Affiliations

  1. 1.Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience CenterSeoul National University Children's Hospital, Seoul National University College of MedicineJongno-guRepublic of Korea
  2. 2.Research Center for Rare DiseaseRepublic of Korea

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