Functional and Angiographic Outcomes Following Surgical Revascularization in Pediatric Moyamoya Disease: A Single-Centre Cohort Study from Central Asia

Background: Moyamoya disease (MMD) is a progressive cerebrovascular disorder and an important cause of ischemic stroke in children. Surgical revascularization is the mainstay of treatment; however, data on functional and angiographic outcomes in pediatric populations, particularly from Central Asia, remain limited. Methods: We conducted a retrospective single-centre cohort study of 45 pediatric patients with MMD who underwent surgical revascularization between 2013 and 2025. Clinical outcomes were assessed using the modified Rankin Scale (mRS), and angiographic outcomes were evaluated using the Matsushima grading system. Associations between clinical, surgical, and radiological factors and functional outcomes were analysed. Results: The mean age at diagnosis was 9.5 ± 3.8 years, with a mean follow-up of 20.6 ± 17.5 months. Headache was the most common presenting symptom (77.8%), while ischemic stroke was the predominant cerebrovascular presentation, occurring in more than 70% of patients. More than 75% of patients had advanced angiographic disease (Suzuki stages IV–V). Functional outcomes improved significantly following surgery, with mean mRS decreasing from 2.09 ± 1.26 to 1.64 ± 1.00 (p = 0.004). At follow-up, 82.2% of patients achieved favorable outcomes (mRS 1–2). Bilateral revascularization was performed in 64.4% of cases. No significant differences were observed between direct, indirect, and combined techniques, although a trend toward improved outcomes with direct and combined approaches was noted. Postoperative collateral formation was strongly associated with functional outcome (p = 0.005). Conclusions: Surgical revascularization is associated with significant functional improvement and low recurrence rates in pediatric MMD. The quality of collateral formation, rather than the surgical technique itself, appears to be the primary determinant of outcome.