title: One sided bypass for bilateral Moyamoya disease, a case report and review of the literatures.
abstract: BACKGROUND
  Moyamoya disease (MMD) is a rare condition, where the most appropriate treatment for it is yet to be determined. Surgery remains an important method of choice although it is considered a form of palliative care. The outcome following surgery is very difficult to judge, and there is no standardised measurement to assess it. It is therefore important to know which approach for such patient is adequate.
  
  
  METHODS
  A 21-year-old male patient presented with signs and symptoms of intracranial haemorrhage. Upon investigation, a diagnosis of bilateral MMD was made, and one sided direct bypass surgery was subsequently performed. At 3-year follow-up, there is no evidence of recurrent cerebral vascular event.
  
  
  CONCLUSIONS
  This case provided further evidence that direct bypass surgery is beneficial for patient in terms of blood flow improvement and symptom relieve. Although there is no consensus on whether bilateral surgical intervention is mandatory for patient with bilateral MMD, unilateral bypass might be sufficient enough. Further study is required to evaluate the best approach for such group of patient.
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital, Kunming Medical University, Kunming 650101, China.
authors.forename: Xuhui
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Second Affiliated Hospital, Kunming Medical University, Kunming 650101, China.
authors.forename: Ninghui
authors.initials: N
authors.lastname: Zhao
authors.affiliation: Clinical Surgery, University of Edinburgh, Edinburgh EH16 4SA, UK. Electronic address: pzyang@doctors.org.uk.
authors.forename: P Zichu
authors.initials: PZ
authors.lastname: Yang
keywords: Cerebral angiography; Intraventricular haemorrhage; Moyamoya disease; Vascular anastomosis