Optimizing Surgical Timing to Reduce Stroke Risk in Pediatric Moyamoya Disease

BACKGROUND: Identifying the optimal surgical timing is critical for reducing stroke risk in pediatric patients with moyamoya disease, but evidence to guide clinical decision-making remains limited. This study aimed to determine the optimal surgical timing based on different symptom onset patterns. METHODS: We retrospectively reviewed pediatric patients with moyamoya disease who underwent revascularization surgery at a single center in China between July 2007 and July 2018. Patients were categorized by symptom onset pattern: infarction-onset, transient ischemic attack (TIA)-onset, or nonischemic. The TIA-onset group was further subdivided into high-risk and low-risk subgroups. Data on preoperative/perioperative stroke events and diagnosis-to-operation intervals were collected. Receiver operating characteristic curves and multivariate analyses were used to identify surgical timing thresholds. Stroke incidences were compared across groups stratified by surgical interval. RESULTS: <0.05) was associated with a significantly increased risk of cerebral hemorrhage. For patients with initial symptoms of infarction or high-risk TIA, earlier surgery did not increase the incidence of perioperative stroke events. CONCLUSIONS: For children with moyamoya disease, surgical intervention was beneficial within 2.5 months for patients with infarction-onset, 6.5 months for patients with high-risk TIA onset, and 5 years for nonischemic patients in reducing stroke risk.