What is the main surgical treatment option for Moyamoya disease in children?

• A. Antiplatelet monotherapy
• B. Revascularization surgery (direct or indirect bypass)
• C. Chemotherapy
• D. Radiation therapy

Answer: (B)

Restoring blood flow to the brain is the central goal in surgically treating Moyamoya in children. The disease causes progressive narrowing of the intracranial vessels, which reduces perfusion and increases the risk of ischemic stroke. Revascularization surgery achieves this by providing a new route for blood to reach the brain.

Direct bypass attaches a scalp artery directly to a brain artery, delivering immediate improved flow. Indirect bypass places vascular tissue near the brain to encourage new blood vessels to grow over weeks to months, gradually boosting perfusion. In children, indirect approaches are often favored because the vessels are small, but direct or combined methods may be used when feasible to achieve quicker restoration of blood supply.

Antiplatelet therapy can help reduce clot-related risk but does not address the underlying perfusion deficit. Chemotherapy and radiation therapy have no role in treating Moyamoya disease.