title: Indirect bypass procedures for moyamoya disease in pediatric patients.
abstract: OBJECTIVE
  Many direct and indirect surgical intervention methods have been defined for the treatment of moyamoya disease. Indirect surgical procedures have been increasingly used. In this study, indirect surgical intervention methods especially used in combination with pial synangiosis were assessed together with other indirect methods.
  
  
  METHODS
  11 patients who were treated with an indirect bypass procedures at our clinic and followed for at least three years were retrospectively examined. 19 surgical interventions were performed for 18 patient hemispheres pertaining to these patients. 4 indirect surgical revascularization methods were used for three patient hemispheres. On the other hand, indirect procedures combined with pial synangiosis were applied in 11 operations. In addition, the "multiple burr-hole surgery" method was used in 4 four operations performed for two patients.
  
  
  RESULTS
  The clinical success rate was 66.6% for patients where the techniques were applied with pial synangiosis. No new ischemic or hemorrhagic attack was observed during the follow-up period in any of these patients in this series.
  
  
  CONCLUSIONS
  Pial synangiosis is a modification that Increases the success rate of indirect surgical methods. In addition, high success rates have been reported in recent publications related to multiple burr-hole surgery. This method is a candidate choice of surgical intervention for selected patients.
authors.affiliation: Ege University, Faculty of Medicine, Department of Neurosurgery, Izmir, Turkey. tuncert@gmail.com
authors.forename: Tuncer
authors.initials: T
authors.lastname: Turhan
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Erşahin
mesh_terms: D000293:Adolescent; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010841:Pia Mater / Q000098:blood supply / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*