Contemporary Management of Moyamoya Disease: Part III—Revascularization Techniques

After a patient has been selected for revascularization surgery, it is necessary to determine which specific revascularization technique is most suited to the particular patient. Revascularization procedures for moyamoya disease (MMD) can be broadly categorized into 2 main categories— direct and indirect—which are differentiated according to whether a direct anastomosis between a donor and a recipient vessel is made. Multiple variations in each of these techniques have been described and understanding which specific procedure is most appropriate in a particular case, when a combination is necessary, and how to preserve preexistent anastomosis is of utmost importance. The complex decision-making process and the required specialized periand intraoperative care explains the superior outcomes in MMD admissions and revascularization procedures in highvolume centers. The third installment of this series describes the various direct and indirect revascularization techniques, their indications, benefits, and drawbacks.