Evidence and Future Prospects of Cerebral Revascularization for Moyamoya Disease

Abstract

  In this review article, the authors discuss the evidence of cerebral revascularization for adult ischemic, adult hemorrhagic, and pediatric moyamoya disease. A recent meta-analysis has confirmed the efficacy of direct bypass for adult ischemic moyamoya disease. For adult hemorrhagic moyamoya disease, the Japan Adult Moyamoya Trial along with several meta-analyses have proved the efficacy of direct bypass against rebleeding and revealed the significance of the hemorrhage site and choroidal anastomosis as predictors for rebleeding. For pediatric moyamoya disease, extremely long-term follow-up studies have revealed the outcome after adolescence. While these studies have confirmed the long-term efficacy of bypass surgery for pediatric cases, they have also addressed the serious issue of de novo hemorrhage occurring in adulthood.