{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T16:22:00Z","timestamp":1794327720749,"version":"4.9.0"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,15]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Moyamoya arteriopathy is a leading cause of cerebral ischemia in children. In pediatric patients with symptomatic or progressive moyamoya disease, surgical revascularization is the mainstay of treatment; however, there is limited comparative evidence demonstrating an advantage of surgical revascularization over nonsurgical management in North American cohorts. The authors aimed to determine whether surgery reduces the risk of subsequent ischemic events in North American children with symptomatic ischemic moyamoya arteriopathy compared to nonsurgical management alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Patients treated conservatively at the Sainte-Justine University Hospital Center in Montr\u00e9al, Canada, were compared to patients treated surgically through indirect revascularization, predominantly performed at the Seattle Children\u2019s Hospital. Data were acquired via retrospective review of patients treated at both institutions. Time to event analysis via multivariable Cox regression for postoperative ipsilateral ischemic stroke or transient ischemic attack (TIA) recurrence was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Forty-nine patients with a median (IQR) age of 6.0 (3.0\u20139.0) years were included. Twenty-four patients (49.0%) were treated nonsurgically, while 25 patients (51.0%) were treated surgically. Among the 42 patients with subtype data available, 15 (35.7%) had moyamoya disease and 27 (64.3%) had moyamoya syndrome. On Kaplan-Meier analysis, patients who underwent nonsurgical management had 12-, 24-, and 60-month recurrence-free rates from an ipsilateral ischemic event of 52.8%, 52.8%, and 31.7%, respectively. In contrast, patients who underwent surgical management had 12-, 24-, and 60-month recurrence-free rates from an ipsilateral ischemic event of 87.7%, 83.0%, and 83.0%, respectively. In the entire cohort, surgical intervention (HR 0.15, 95% CI 0.04\u20130.51) and White race (HR 0.18, 95% CI 0.06\u20130.56) were both independently associated with longer time to ipsilateral ischemic event recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Pediatric patients with symptomatic ischemic moyamoya arteriopathy treated nonsurgically had worse outcomes compared with those managed surgically. These findings support pursuing surgical revascularization therapy in North American children and youth with symptomatic ischemic moyamoya arteriopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.10.peds25220","type":"journal-article","created":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T02:23:02Z","timestamp":1778898182000},"page":"205-213","source":"Crossref","is-referenced-by-count":1,"title":["Surgical revascularization versus nonsurgical management in children with symptomatic moyamoya arteriopathy: a North American multicenter cohort study"],"prefix":"10.3171","volume":"38","author":[{"given":"Lior M.","family":"Elkaim","sequence":"first","affiliation":[{"name":"Department of Neurology and Neurological Surgery, McGill University, Montr\u00e9al, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Shu","family":"Chen","sequence":"additional","affiliation":[{"name":"The Warren Alpert Medical School of Brown University, Providence, Rhode Island;"},{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac Josh","family":"Abecassis","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Louisville, Kentucky;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alissa","family":"Sigal","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, McGill University, Montr\u00e9al, Qu\u00e9bec;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aria","family":"Fallah","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, Los Angeles, Mattel Children\u2019s Hospital, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Venne","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Center, University of Montr\u00e9al, Qu\u00e9bec, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Amlie-Lefond","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"},{"name":"Department of Neurology, University of Washington, Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aristides","family":"Hadjinicolaou","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montr\u00e9al, Qu\u00e9bec;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Jabre","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Montr\u00e9al Hospital Center (CHUM), Montr\u00e9al, Qu\u00e9bec;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matsanga Leyila","family":"Kaseka","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montr\u00e9al, Qu\u00e9bec;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard G.","family":"Ellenbogen","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony C.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, Los Angeles, Mattel Children\u2019s Hospital, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander G.","family":"Weil","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, Sainte-Justine University Hospital Center, University of Montr\u00e9al, Qu\u00e9bec, Canada;"},{"name":"Division of Neurosurgery, Department of Surgery, University of Montr\u00e9al Hospital Center (CHUM), Montr\u00e9al, Qu\u00e9bec;"},{"name":"Brain and Development Research Axis, Sainte-Justine Research Center, Montr\u00e9al, Qu\u00e9bec; and"},{"name":"Department of Neuroscience, University of Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Shinkei","first-page":"37","article-title":"Hypogenesis of bilateral internal carotid artery","volume":"9","author":"Takeuchi K","year":"1957","unstructured":"Takeuchi K, Shimizu K. 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