Long-term Outcome after Surgical Revascularization in Childhood Moyamoya Disease

We assessed long-term outcome after surgical revascularization in childhood moyamoya disease. During the past 20 years, 51 children with moyamoya disease were treated in our hospital. All but 1 child underwent surgical revascularization, either indirect bypass surgery or STA-MCA anastomosis combined with indirect bypass surgery. The mean follow-up period was 9.7 years. Surgical revascularization remarkably reduced or completely resolved ischemic attacks, although postoperative incidences of TIA or headache were significantly higher in children who underwent indirect bypass surgery than in those who underwent STA-MCA anastomosis combined with indirect bypass surgery.Postoperative SPECT studies also showed that STA-MCA anastomosis combined with indirect surgery improved hemodynamics in the frontal lobe. The children with TIA had a better intellectual outcome than those with cerebral infarction. If children with TIA underwent surgical revascularization soon after onset, they were able to pursue higher education and careers. Intracranial bleeding has not been observed in any subject during follow-up periods. These results suggest that surgical revascularization can improve long-term outcome in childhood moyamoya disease if the patients undergo the procedure soon after onset.