Abstract Background and aims Moyamoya disease is a rare progressive cerebrovascular arteriopathy causing stenosis of intracranial arteries and abnormal collateral formation. Surgical revascularization is the main treatment to prevent ischemic events, however data on clinical and radiological outcomes are limited. This study evaluated clinical and radiological outcomes in pediatric patients undergoing different revascularization procedures at our center. Methods Patients aged 1 month to 18 years (mean 9.1 ± 3.78 years) with Moyamoya disease who underwent cerebral revascularization at the National Neurosurgical Center between 2013 and 2023 were retrospectively analyzed. Data included demographics, presenting symptoms, mRS at admission, surgical technique, and clinical and radiological outcomes. Results In this retrospective study, 36 pediatric patients with Moyamoya disease were included (19 males, 17 females). The most common presenting symptom was ischemic stroke, observed in 69.5% of patients. Preoperative angiography revealed Suzuki stage V in 38.9% and stage IV in 33.3% of patients. A total of 60 revascularization procedures were performed: direct STA-MCA bypass in 51.7% of cases and combined direct + indirect techniques in 28.3% of cases. During the postoperative follow-up period (1–10 years), ischemic events occurred in 2 patients. Postoperative collateral formation assessed by the Matsushima scale was grade A in 52.8% and grade B in 38.9% of patients. The most favorable outcomes were observed in patients undergoing bilateral direct or combined revascularization. Conclusions Cerebral revascularization in pediatric Moyamoya disease improves clinical outcomes and collateral formation, with bilateral direct or combined procedures providing the most favorable functional and angiographic results. Conflict of interest Iroda Mammadinova: nothing to disclose. Chingiz Nurimanov: nothing to disclose. David Pochivalov: nothing to disclose. Karashash Menlibayeva: nothing to disclose. Ainur Turzhanova: nothing to disclose. Assel Kabykenova: nothing to disclose. Daultai Batyrkhanov: nothing to disclose. Seitzhan Aidarov: nothing to disclose. Assylbek Kaliyev: nothing to disclose. Yerbol Makhambetov: nothing to disclose. Figure 1 - belongs to Results
Mammadinova et al. (Fri,) studied this question.