Abstract
Moyamoya disease (MMD) is a unique cerebrovascular disease with unknown etiology. It is characterized by progressive stenosis of the terminal portion of the internal carotid artery and abnormal vascular network formation at the base of the brain. Surgical revascularization not only prevents ischemic attack by improving cerebral blood flow, but also reduces the risk of re-bleeding in patients with intracerebral hemorrhage at the posterior circulation territory. Regarding surgical procedure, recent studies have indicated the effectiveness of direct/indirect combined revascularization surgery, such as superficial temporal artery-middle cerebral artery anastomosis with pial synangiosis. Despite its long-term favorable outcome, local cerebral hyperperfusion syndrome and cerebral infarction caused by watershed shift phenomenon are potential complications of this procedure. Therefore, routine hemodynamic study and intensive perioperative management, including strict blood pressure control and administration of neuroprotective agents, are essential for a favorable outcome.
