{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:33:34Z","timestamp":1783776814146,"version":"3.55.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2009,4]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Different revascularization procedures are used in the treatment of patients with moyamoya disease (MMD). The aim of this study was to investigate the relative contribution of direct and indirect revascularization procedures to the restoration of collateral blood supply in adult and pediatric patients with MMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors performed 39 combined cerebral revascularization procedures (standard extraintracranial bypass [STA-MCA bypass] plus encephalomyosynangiosis [EMS]) in 10 pediatric and 10 adult patients. All patients underwent physical examination and digital subtraction angiography before and 6 months after surgery. The STA-MCA bypass and EMS function were graded as Grade I (poor), II (moderate), or III (good) on the basis of the angiograms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In pediatric patients, bypass function was Grade I in 12, Grade II in 8, and Grade III in 0 hemispheres; EMS function was Grade I in 0, Grade II in 12, and Grade III in 8 hemispheres. In the adult patients, bypass function was Grade I in 8, Grade II in 8, and Grade III in 3 hemispheres; EMS function was Grade I in 10 hemispheres, Grade II in 5, and Grade III in 1 hemisphere. In the pediatric patients disease was classified as improved in 14 hemispheres on the basis of clinical results and stable in 6. In the adults it was classified as improved in 12 hemispheres stable in 7 hemispheres.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Combined revascularization led to good angiographic and clinical results in both patient populations. Especially in pediatric patients, EMS represents a suitable alternative to bypass surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2009.1.focus08298","type":"journal-article","created":{"date-parts":[[2009,3,31]],"date-time":"2009-03-31T12:12:42Z","timestamp":1238501562000},"page":"E9","source":"Crossref","is-referenced-by-count":49,"title":["Age-dependent revascularization patterns in the treatment of moyamoya disease in a European patient population"],"prefix":"10.3171","volume":"26","author":[{"given":"Marcus","family":"Czabanka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vajkoczy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Schmiedek","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Klinikum Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Charit\u00e9-Universit\u00e4tsmedizin Berlin; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0260009","series-title":"AJNR Am J Neuroradiol","first-page":"29","article-title":"Angiography of encephalomyosynangiosis and superficial temporal artery to middle cerebral artery anastomosis in moyamoya disease","volume":"14","author":"Asfora","year":"1993"},{"key":"b2-0260009","series-title":"Stroke","first-page":"1703","article-title":"Characterization of cortical microvascularization in adult moyamoya disease","volume":"39","author":"Czabanka","year":"2008"},{"key":"b3-0260009","series-title":"Childs Nerv Syst","first-page":"358","article-title":"Revascularization surgery for paediatric moyamoya: a review of the literature","volume":"21","author":"Fung","year":"2005"},{"key":"b4-0260009","series-title":"Neurosurgery","first-page":"50","article-title":"Direct and combined revascularization in pediatric moyamoya disease","volume":"45","author":"Golby","year":"1999"},{"key":"b5-0260009","series-title":"Acta Neurochir (Wien)","first-page":"1263","article-title":"A co-operative study: clinical characteristics of 334 Korean patients with moyamoya disease treated at neurosurgical institutes (1976-1994). The Korean Society for Cerebrovascular Disease","volume":"142","author":"Han","year":"2000"},{"key":"b6-0260009","series-title":"Langenbecks Arch Klin Chir Ver Dtsch Z Chir","first-page":"392","article-title":"Surgical revascularization of cerebral injury of circulatory origin by means of stratification of pedunculated muscle flaps","volume":"264","author":"Henschen","year":"1950"},{"key":"b7-0260009","series-title":"Childs Nerv Syst","first-page":"382","article-title":"Moyamoya-like vasculopathy (moyamoya syndrome) in children","volume":"20","author":"Horn","year":"2004"},{"key":"b8-0260009","series-title":"Neuroradiology","first-page":"723","article-title":"Evaluation of extracranial-intracranial arterial bypass function with magnetic resonance angiography","volume":"46","author":"Horn","year":"2004"},{"key":"b9-0260009","series-title":"AJNR Am J Neuroradiol","first-page":"1543","article-title":"Xenon-induced flow activation in patients with cerebral insult who undergo xenon-enhanced CT blood flow studies","volume":"22","author":"Horn","year":"2001"},{"key":"b10-0260009","series-title":"Stroke","first-page":"1342","article-title":"Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage?","volume":"27","author":"Houkin","year":"1996"},{"key":"b11-0260009","series-title":"Childs Nerv Syst","first-page":"24","article-title":"Combined revascularization surgery for childhood moyamoya disease: STA-MCA and encephalo-duro-arterio-myo-synangiosis","volume":"13","author":"Houkin","year":"1997"},{"key":"b12-0260009","series-title":"Neurosurg Clin N Am","first-page":"575","article-title":"Cerebral revascularization for moyamoya disease in children","volume":"12","author":"Houkin","year":"2001"},{"key":"b13-0260009","series-title":"Stroke","first-page":"1170","article-title":"Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease","volume":"28","author":"Ishikawa","year":"1997"},{"key":"b14-0260009","series-title":"Acta Neurochir Suppl","first-page":"127","article-title":"Moyamoya angiopathy in Europe: the beginnings in Zurich, practical lessons learned, increasing awareness and future perspectives","volume":"103","author":"Khan","year":"2008"},{"issue":"5","key":"b15-0260009","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Multiple combined indirect procedure for the surgical treatment of children with moyamoya disease. A comparison with single indirect anastomosis and direct anastomosis","volume":"5","author":"Matsushima","year":"1998"},{"key":"b16-0260009","series-title":"Clin Neurol Neurosurg","article-title":"Efficacy of the revascularization surgery for adult-onset moyamoya disease with the progression of cerebrovascular lesions","author":"Narisawa","year":"2008"},{"key":"b17-0260009","series-title":"J Neurosurg","first-page":"869","article-title":"Power Doppler imaging in detection of surgically induced indirect neoangiogenesis in adult moyamoya disease","volume":"103","author":"Perren","year":"2005"},{"key":"b18-0260009","series-title":"Neurology","first-page":"558","article-title":"Power Doppler evaluation of revascularization in childhood moyamoya","volume":"64","author":"Perren","year":"2005"},{"issue":"2","key":"b19-0260009","series-title":"Neurosurg Focus","first-page":"E17","article-title":"Progression of disease in unilateral moyamoya syndrome","volume":"24","author":"Smith","year":"2008"},{"key":"b20-0260009","series-title":"Skull Base","first-page":"15","article-title":"Surgical management of moyamoya syndrome","volume":"15","author":"Smith","year":"2005"},{"key":"b21-0260009","series-title":"Arch Neurol","first-page":"288","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki","year":"1969"},{"key":"b22-0260009","series-title":"Oper Tech Neurosurg","first-page":"106","article-title":"Standard superficial temporal artery-middle cerebral artery bypass surgery in hemodynamic cerebral ischemia: indication and technique","volume":"2","author":"Vajkoczy","year":"1998"},{"key":"b23-0260009","series-title":"Microneurosurgery","volume":"Vol 1","author":"Ya\u015fargil","year":"1984"},{"key":"b1-0260009","series-title":"AJNR Am J Neuroradiol","first-page":"29","article-title":"Angiography of encephalomyosynangiosis and superficial temporal artery to middle cerebral artery anastomosis in moyamoya disease","volume":"14","author":"Asfora","year":"1993"},{"key":"b2-0260009","series-title":"Stroke","first-page":"1703","article-title":"Characterization of cortical microvascularization in adult moyamoya disease","volume":"39","author":"Czabanka","year":"2008"},{"key":"b3-0260009","series-title":"Childs Nerv Syst","first-page":"358","article-title":"Revascularization surgery for paediatric moyamoya: a review of the literature","volume":"21","author":"Fung","year":"2005"},{"key":"b4-0260009","series-title":"Neurosurgery","first-page":"50","article-title":"Direct and combined revascularization in pediatric moyamoya disease","volume":"45","author":"Golby","year":"1999"},{"key":"b5-0260009","series-title":"Acta Neurochir (Wien)","first-page":"1263","article-title":"A co-operative study: clinical characteristics of 334 Korean patients with moyamoya disease treated at neurosurgical institutes (1976-1994). The Korean Society for Cerebrovascular Disease","volume":"142","author":"Han","year":"2000"},{"key":"b6-0260009","series-title":"Langenbecks Arch Klin Chir Ver Dtsch Z Chir","first-page":"392","article-title":"Surgical revascularization of cerebral injury of circulatory origin by means of stratification of pedunculated muscle flaps","volume":"264","author":"Henschen","year":"1950"},{"key":"b7-0260009","series-title":"Childs Nerv Syst","first-page":"382","article-title":"Moyamoya-like vasculopathy (moyamoya syndrome) in children","volume":"20","author":"Horn","year":"2004"},{"key":"b8-0260009","series-title":"Neuroradiology","first-page":"723","article-title":"Evaluation of extracranial-intracranial arterial bypass function with magnetic resonance angiography","volume":"46","author":"Horn","year":"2004"},{"key":"b9-0260009","series-title":"AJNR Am J Neuroradiol","first-page":"1543","article-title":"Xenon-induced flow activation in patients with cerebral insult who undergo xenon-enhanced CT blood flow studies","volume":"22","author":"Horn","year":"2001"},{"key":"b10-0260009","series-title":"Stroke","first-page":"1342","article-title":"Surgical therapy for adult moyamoya disease. Can surgical revascularization prevent the recurrence of intracerebral hemorrhage?","volume":"27","author":"Houkin","year":"1996"},{"key":"b11-0260009","series-title":"Childs Nerv Syst","first-page":"24","article-title":"Combined revascularization surgery for childhood moyamoya disease: STA-MCA and encephalo-duro-arterio-myo-synangiosis","volume":"13","author":"Houkin","year":"1997"},{"key":"b12-0260009","series-title":"Neurosurg Clin N Am","first-page":"575","article-title":"Cerebral revascularization for moyamoya disease in children","volume":"12","author":"Houkin","year":"2001"},{"key":"b13-0260009","series-title":"Stroke","first-page":"1170","article-title":"Effects of surgical revascularization on outcome of patients with pediatric moyamoya disease","volume":"28","author":"Ishikawa","year":"1997"},{"key":"b14-0260009","series-title":"Acta Neurochir Suppl","first-page":"127","article-title":"Moyamoya angiopathy in Europe: the beginnings in Zurich, practical lessons learned, increasing awareness and future perspectives","volume":"103","author":"Khan","year":"2008"},{"issue":"5","key":"b15-0260009","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Multiple combined indirect procedure for the surgical treatment of children with moyamoya disease. 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Disease showing abnormal net-like vessels in base of brain","volume":"20","author":"Suzuki","year":"1969"},{"key":"b22-0260009","series-title":"Oper Tech Neurosurg","first-page":"106","article-title":"Standard superficial temporal artery-middle cerebral artery bypass surgery in hemodynamic cerebral ischemia: indication and technique","volume":"2","author":"Vajkoczy","year":"1998"},{"key":"b23-0260009","series-title":"Microneurosurgery","volume":"Vol 1","author":"Ya\u015fargil","year":"1984"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/26\/4\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/26\/4\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/26\/4\/article-pE9.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:11:09Z","timestamp":1780733469000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/26\/4\/article-pE9.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,4]]},"references-count":46,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2009.1.focus08298","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,4]]}}}