{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:13:58Z","timestamp":1772828038209,"version":"3.50.1"},"reference-count":54,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,24]]},"abstract":"\n OBJECTIVE<\/jats:title>\n The Matsushima grading system is widely used to evaluate angiographic revascularization outcomes after pial synangiosis for moyamoya vasculopathy by quantifying collateral ingrowth. The authors hypothesized that the orbital grading system (OGS), a new scale developed for adults to measure collateral ingrowth, would provide greater consistency and interrater reliability. They aimed to compare the performance of these scales for the first time in the pediatric population.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n The authors performed a retrospective analysis of patients with moyamoya vasculopathy with follow-up catheter angiography after indirect revascularization at a single major pediatric center from 2006 to 2023. An interrater reliability analysis was performed using 5 raters with varying levels of training, who provided scores for 30 blinded cases. Fleiss\u2019 kappa coefficient (\u03ba) was calculated as a measure of agreement beyond chance.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n A total of 101 patients with a median age of 9 years, of predominantly female sex (56.4%) who were mostly affected by moyamoya disease (71.3%) were included. A total of 158 cerebral hemispheres were treated with pial synangiosis (57 patients had bilateral surgeries). Most hemispheres were categorized as Suzuki stage 3 or above (82.9%). At a median of 12.4 months postoperatively, collateral growth was classified as Matsushima grade A in 57.6%, B in 24.1%, C in 14.6%, and as borderline grades in 3.8%. The OGS scores were grade 0 in 7.0%, grade 1 in 8.9%, grade 2 in 43.7%, and grade 3 in 40.5%. Interrater agreement evaluation revealed that the OGS had a superior \u03ba value compared with the Matsushima scale (0.51 vs 0.15, p < 0.001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The OGS had higher interrater agreement rates than the Matsushima scale for identifying postoperative collateral ingrowth in children after pial synangiosis. This scale provides a more consistent method for evaluating angiographic outcomes after indirect revascularization in the pediatric population.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.7.peds25242","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T02:15:00Z","timestamp":1761358500000},"page":"69-76","source":"Crossref","is-referenced-by-count":0,"title":["The orbital grading system in pediatric moyamoya: an interrater reliability analysis of angiographic outcomes"],"prefix":"10.3171","volume":"37","author":[{"given":"Alejandro","family":"Enriquez-Marulanda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"},{"name":"Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcella","family":"Ruppert-Gomez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrisha","family":"Lazatin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Staffa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"},{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivani D.","family":"Rangwala","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren B.","family":"Orbach","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfred P.","family":"See","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Boston Children\u2019s Hospital, Harvard Medical School, Boston;"},{"name":"Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"12","key":"b1","series-title":"N Engl J Med","first-page":"1226","article-title":"Moyamoya disease and moyamoya syndrome","volume":"360","author":"Scott RM","year":"2009","unstructured":"Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009;360(12):1226\u20131237."},{"issue":"2","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"173","article-title":"Encephaloduroarteriosynangiosis for pediatric moyamoya disease: long-term follow-up of 100 cases at a single center","volume":"22","author":"Zhang Y","year":"2018","unstructured":"Zhang Y, Bao XY, Duan L, Encephaloduroarteriosynangiosis for pediatric moyamoya disease: long-term follow-up of 100 cases at a single center. J Neurosurg Pediatr. 2018;22(2):173\u2013180."},{"issue":"1","key":"b3","series-title":"Oper Neurosurg (Hagerstown)","first-page":"E14","article-title":"General principles for pial synangiosis in pediatric moyamoya patients: 2-dimensional operative video","volume":"16","author":"Penn DL","year":"2019","unstructured":"Penn DL, Wu KC, Presswood KR, Riordan CP, Scott RM, Smith ER. General principles for pial synangiosis in pediatric moyamoya patients: 2-dimensional operative video. Oper Neurosurg (Hagerstown). 2019;16(1):E14\u2013E15."},{"issue":"1","key":"b4","series-title":"Clin Neuroradiol","first-page":"91","article-title":"Time course of neoangiogenesis after indirect bypass surgery for moyamoya disease: comparison of short-term and long-term follow-up angiography","volume":"30","author":"Zhao Y","year":"2020","unstructured":"Zhao Y, Lu J, Zhang Q, Time course of neoangiogenesis after indirect bypass surgery for moyamoya disease: comparison of short-term and long-term follow-up angiography. Clin Neuroradiol. 2020;30(1):91\u201399."},{"issue":"3","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"269","article-title":"Neovascularization (angiogenesis) after revascularization in moyamoya disease. Which technique is most useful for moyamoya disease?","volume":"142","author":"Houkin K","year":"2000","unstructured":"Houkin K, Kuroda S, Ishikawa T, Abe H. Neovascularization (angiogenesis) after revascularization in moyamoya disease. Which technique is most useful for moyamoya disease?. Acta Neurochir (Wien). 2000;142(3):269\u2013276."},{"issue":"5","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"586","article-title":"Results of more than 20 years of follow-up in pediatric patients with moyamoya disease undergoing pial synangiosis","volume":"23","author":"Riordan CP","year":"2019","unstructured":"Riordan CP, Storey A, Cote DJ, Smith ER, Scott RM. Results of more than 20 years of follow-up in pediatric patients with moyamoya disease undergoing pial synangiosis. J Neurosurg Pediatr. 2019;23(5):586\u2013592."},{"issue":"2 Suppl Pediatrics","key":"b7","series-title":"J Neurosurg","first-page":"142","article-title":"Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis","volume":"100","author":"Scott RM","year":"2004","unstructured":"Scott RM, Smith JL, Robertson RL, Madsen JR, Soriano SG, Rockoff MA. Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg. 2004;100(2 Suppl Pediatrics):142-149."},{"issue":"11","key":"b8","series-title":"Stroke","first-page":"3177","article-title":"Long-term outcomes of indirect bypass for 629 children with moyamoya disease: longitudinal and cross-sectional analysis","volume":"50","author":"Ha EJ","year":"2019","unstructured":"Ha EJ, Kim KH, Wang KC, Long-term outcomes of indirect bypass for 629 children with moyamoya disease: longitudinal and cross-sectional analysis. Stroke. 2019;50(11):3177\u20133183."},{"issue":"5","key":"b9","series-title":"Stroke Vasc Interv Neurol","first-page":"e001348","article-title":"Long-term hemorrhagic morbidity for children with moyamoya treated with revascularization surgery in a single center retrospective cohort","volume":"4","author":"See AP","year":"2024","unstructured":"See AP, Kocher SD, Piwowarczyk P, Long-term hemorrhagic morbidity for children with moyamoya treated with revascularization surgery in a single center retrospective cohort. Stroke Vasc Interv Neurol. 2024;4(5):e001348."},{"issue":"3","key":"b10","series-title":"Neurosurgery","first-page":"401","article-title":"Surgical treatment of moyamoya disease in pediatric patients\u2013comparison between the results of indirect and direct revascularization procedures","volume":"31","author":"Matsushima T","year":"1992","unstructured":"Matsushima T, Inoue T, Suzuki SO, Fujii K, Fukui M, Hasuo K. Surgical treatment of moyamoya disease in pediatric patients\u2013comparison between the results of indirect and direct revascularization procedures. Neurosurgery. 1992;31(3):401\u2013405."},{"issue":"2","key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"260","article-title":"Standardized MR perfusion scoring system for evaluation of sequential perfusion changes and surgical outcome of moyamoya disease","volume":"40","author":"Lin YH","year":"2019","unstructured":"Lin YH, Kuo MF, Lu CJ, Standardized MR perfusion scoring system for evaluation of sequential perfusion changes and surgical outcome of moyamoya disease. AJNR Am J Neuroradiol. 2019;40(2):260\u2013266."},{"key":"b12","series-title":"World Neurosurg","first-page":"e697","article-title":"Characterizing revascularization after encephalo-duro-arterio-synangiosis (EDAS) in adult patients with moyamoya disease using the orbital grading system","volume":"191","author":"Alwakaa O","year":"2024","unstructured":"Alwakaa O, Enriquez-Marulanda A, Ramirez-Velandia F, Characterizing revascularization after encephalo-duro-arterio-synangiosis (EDAS) in adult patients with moyamoya disease using the orbital grading system. World Neurosurg. 2024;191:e697\u2013e706."},{"issue":"3","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"351","article-title":"Long-term clinical and radiographic outcomes after pial pericranial dural revascularization: a hybrid surgical technique for treatment of anterior cerebral territory ischemia in pediatric moyamoya disease","volume":"28","author":"Montaser A","year":"2021","unstructured":"Montaser A, Driscoll J, Smith H, Long-term clinical and radiographic outcomes after pial pericranial dural revascularization: a hybrid surgical technique for treatment of anterior cerebral territory ischemia in pediatric moyamoya disease. J Neurosurg Pediatr. 2021;28(3):351\u2013359."},{"issue":"6","key":"b14","series-title":"J Korean Neurosurg Soc","first-page":"415","article-title":"Moyamoya biomarkers","volume":"57","author":"Smith ER","year":"2015","unstructured":"Smith ER. Moyamoya biomarkers. J Korean Neurosurg Soc. 2015;57(6):415\u2013421."},{"key":"b15","series-title":"Front Neurol","first-page":"1115343","article-title":"Ultrasonic hemodynamic changes of superficial temporal artery graft in different angiogenesis outcomes of moyamoya disease patients treated with combined revascularization surgery","volume":"14","author":"Chen S","year":"2023","unstructured":"Chen S, Wang B, Wen Y, Ultrasonic hemodynamic changes of superficial temporal artery graft in different angiogenesis outcomes of moyamoya disease patients treated with combined revascularization surgery. Front Neurol. 2023;14:1115343."},{"issue":"11","key":"b16","series-title":"Eur Radiol","first-page":"8364","article-title":"Encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome: evaluation by computed tomography perfusion imaging","volume":"31","author":"Guo X","year":"2021","unstructured":"Guo X, Yuan X, Gao L, Encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome: evaluation by computed tomography perfusion imaging. Eur Radiol. 2021;31(11):8364\u20138373."},{"issue":"4","key":"b17","series-title":"Acta Neurochir (Wien)","first-page":"377","article-title":"Efficacy of direct revascularization in adult moyamoya disease: haemodynamic evaluation by positron emission tomography","volume":"141","author":"Morimoto M","year":"1999","unstructured":"Morimoto M, Iwama T, Hashimoto N, Kojima A, Hayashida K. Efficacy of direct revascularization in adult moyamoya disease: haemodynamic evaluation by positron emission tomography. Acta Neurochir (Wien). 1999;141(4):377\u2013384."},{"issue":"4","key":"b18","series-title":"Pediatr Neurosurg","first-page":"143","article-title":"Axial magnetic resonance angiography in evaluating revascularization after indirect bypass surgery for moyamoya axial magnetic resonance angiography after indirect bypass","volume":"59","author":"Elbadry RG","year":"2024","unstructured":"Elbadry RG, Neuberger I, Ryan MV, Axial magnetic resonance angiography in evaluating revascularization after indirect bypass surgery for moyamoya axial magnetic resonance angiography after indirect bypass. Pediatr Neurosurg. 2024;59(4):143\u2013164."},{"issue":"4","key":"b19","series-title":"AJNR Am J Neuroradiol","first-page":"741","article-title":"Postoperative evaluation of moyamoya disease with perfusion-weighted MR imaging: initial experience","volume":"24","author":"Lee SK","year":"2003","unstructured":"Lee SK, Kim DI, Jeong EK, Postoperative evaluation of moyamoya disease with perfusion-weighted MR imaging: initial experience. AJNR Am J Neuroradiol. 2003;24(4):741\u2013747."},{"issue":"11","key":"b20","series-title":"AJNR Am J Neuroradiol","first-page":"1582","article-title":"The value of preoperative phase-contrast MRI in predicting the clinical outcome of moyamoya disease after encephalo-duro-arterial synangiosis surgery","volume":"43","author":"Liu S","year":"2022","unstructured":"Liu S, Lu M, Han C, The value of preoperative phase-contrast MRI in predicting the clinical outcome of moyamoya disease after encephalo-duro-arterial synangiosis surgery. AJNR Am J Neuroradiol. 2022;43(11):1582\u20131588."},{"issue":"1","key":"b21","series-title":"J Neurosurg Pediatr","first-page":"40","article-title":"Arterial spin labeling as an ancillary assessment to postoperative conventional angiogram in pediatric moyamoya disease","volume":"29","author":"Lang SS","year":"2022","unstructured":"Lang SS, Tucker AM, Schreiber C, Arterial spin labeling as an ancillary assessment to postoperative conventional angiogram in pediatric moyamoya disease. J Neurosurg Pediatr. 2022;29(1):40\u201347."},{"issue":"8","key":"b22","series-title":"Acta Neurochir (Wien)","first-page":"2057","article-title":"ASL-MRI-guided evaluation of multiple burr hole revascularization surgery in moyamoya disease","volume":"165","author":"Lew\u00e9n A","year":"2023","unstructured":"Lew\u00e9n A, Fahlstr\u00f6m M, Borota L, Larsson EM, Wikstr\u00f6m J, Enblad P. ASL-MRI-guided evaluation of multiple burr hole revascularization surgery in moyamoya disease. Acta Neurochir (Wien). 2023;165(8):2057\u20132069."},{"issue":"17","key":"b23","series-title":"Heliyon","first-page":"e37368","article-title":"Pseudo-continuous and territorial arterial spin labeling MRI for assessment of cerebral perfusion in moyamoya disease after revascularization: a comparative study with digital subtraction angiography","volume":"10","author":"Li J","year":"2024","unstructured":"Li J, Meng Q, Huang L, Pylypenko D, Zhong H. Pseudo-continuous and territorial arterial spin labeling MRI for assessment of cerebral perfusion in moyamoya disease after revascularization: a comparative study with digital subtraction angiography. Heliyon. 2024;10(17):e37368."},{"issue":"1","key":"b24","series-title":"Neurosurgery","first-page":"261","article-title":"Clinical use of cerebrovascular compliance imaging to evaluate revascularization in patients with moyamoya","volume":"84","author":"Watchmaker JM","year":"2019","unstructured":"Watchmaker JM, Frederick B D, Fusco MR, Clinical use of cerebrovascular compliance imaging to evaluate revascularization in patients with moyamoya. Neurosurgery. 2019;84(1):261\u2013271."},{"issue":"4","key":"b25","series-title":"J Neurosurg Pediatr","first-page":"458","article-title":"Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya","volume":"29","author":"Montaser AS","year":"2022","unstructured":"Montaser AS, Lalgudi Srinivasan H, Staffa SJ, Ivy sign: a diagnostic and prognostic biomarker for pediatric moyamoya. J Neurosurg Pediatr. 2022;29(4):458\u2013466."},{"issue":"2_suppl","key":"b26","series-title":"J Cereb Blood Flow Metab","first-page":"138","article-title":"Revascularization improves vascular hemodynamics - a study assessing cerebrovascular reserve and transit time in Moyamoya patients using MRI","volume":"43","author":"Zhao MY","year":"2023","unstructured":"Zhao MY, Armindo RD, Gauden AJ, Revascularization improves vascular hemodynamics - a study assessing cerebrovascular reserve and transit time in Moyamoya patients using MRI. J Cereb Blood Flow Metab. 2023;43(2_suppl):138\u2013151."},{"issue":"2","key":"b27","series-title":"iScience","first-page":"108923","article-title":"Evaluation of cerebrovascular reactivity in moyamoya disease using oxygen-dependent magnetic resonance imaging","volume":"27","author":"He S","year":"2024","unstructured":"He S, Wang X, Niu H, Evaluation of cerebrovascular reactivity in moyamoya disease using oxygen-dependent magnetic resonance imaging. iScience. 2024;27(2):108923."},{"issue":"12","key":"b1","series-title":"N Engl J Med","first-page":"1226","article-title":"Moyamoya disease and moyamoya syndrome","volume":"360","author":"Scott RM","year":"2009","unstructured":"Scott RM, Smith ER. Moyamoya disease and moyamoya syndrome. N Engl J Med. 2009;360(12):1226\u20131237."},{"issue":"2","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"173","article-title":"Encephaloduroarteriosynangiosis for pediatric moyamoya disease: long-term follow-up of 100 cases at a single center","volume":"22","author":"Zhang Y","year":"2018","unstructured":"Zhang Y, Bao XY, Duan L, Encephaloduroarteriosynangiosis for pediatric moyamoya disease: long-term follow-up of 100 cases at a single center. J Neurosurg Pediatr. 2018;22(2):173\u2013180."},{"issue":"1","key":"b3","series-title":"Oper Neurosurg (Hagerstown)","first-page":"E14","article-title":"General principles for pial synangiosis in pediatric moyamoya patients: 2-dimensional operative video","volume":"16","author":"Penn DL","year":"2019","unstructured":"Penn DL, Wu KC, Presswood KR, Riordan CP, Scott RM, Smith ER. General principles for pial synangiosis in pediatric moyamoya patients: 2-dimensional operative video. Oper Neurosurg (Hagerstown). 2019;16(1):E14\u2013E15."},{"issue":"1","key":"b4","series-title":"Clin Neuroradiol","first-page":"91","article-title":"Time course of neoangiogenesis after indirect bypass surgery for moyamoya disease: comparison of short-term and long-term follow-up angiography","volume":"30","author":"Zhao Y","year":"2020","unstructured":"Zhao Y, Lu J, Zhang Q, Time course of neoangiogenesis after indirect bypass surgery for moyamoya disease: comparison of short-term and long-term follow-up angiography. Clin Neuroradiol. 2020;30(1):91\u201399."},{"issue":"3","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"269","article-title":"Neovascularization (angiogenesis) after revascularization in moyamoya disease. Which technique is most useful for moyamoya disease?","volume":"142","author":"Houkin K","year":"2000","unstructured":"Houkin K, Kuroda S, Ishikawa T, Abe H. Neovascularization (angiogenesis) after revascularization in moyamoya disease. Which technique is most useful for moyamoya disease?. Acta Neurochir (Wien). 2000;142(3):269\u2013276."},{"issue":"5","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"586","article-title":"Results of more than 20 years of follow-up in pediatric patients with moyamoya disease undergoing pial synangiosis","volume":"23","author":"Riordan CP","year":"2019","unstructured":"Riordan CP, Storey A, Cote DJ, Smith ER, Scott RM. Results of more than 20 years of follow-up in pediatric patients with moyamoya disease undergoing pial synangiosis. J Neurosurg Pediatr. 2019;23(5):586\u2013592."},{"issue":"2 Suppl Pediatrics","key":"b7","series-title":"J Neurosurg","first-page":"142","article-title":"Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis","volume":"100","author":"Scott RM","year":"2004","unstructured":"Scott RM, Smith JL, Robertson RL, Madsen JR, Soriano SG, Rockoff MA. Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg. 2004;100(2 Suppl Pediatrics):142-149."},{"issue":"11","key":"b8","series-title":"Stroke","first-page":"3177","article-title":"Long-term outcomes of indirect bypass for 629 children with moyamoya disease: longitudinal and cross-sectional analysis","volume":"50","author":"Ha EJ","year":"2019","unstructured":"Ha EJ, Kim KH, Wang KC, Long-term outcomes of indirect bypass for 629 children with moyamoya disease: longitudinal and cross-sectional analysis. Stroke. 2019;50(11):3177\u20133183."},{"issue":"5","key":"b9","series-title":"Stroke Vasc Interv Neurol","first-page":"e001348","article-title":"Long-term hemorrhagic morbidity for children with moyamoya treated with revascularization surgery in a single center retrospective cohort","volume":"4","author":"See AP","year":"2024","unstructured":"See AP, Kocher SD, Piwowarczyk P, Long-term hemorrhagic morbidity for children with moyamoya treated with revascularization surgery in a single center retrospective cohort. Stroke Vasc Interv Neurol. 2024;4(5):e001348."},{"issue":"3","key":"b10","series-title":"Neurosurgery","first-page":"401","article-title":"Surgical treatment of moyamoya disease in pediatric patients\u2013comparison between the results of indirect and direct revascularization procedures","volume":"31","author":"Matsushima T","year":"1992","unstructured":"Matsushima T, Inoue T, Suzuki SO, Fujii K, Fukui M, Hasuo K. Surgical treatment of moyamoya disease in pediatric patients\u2013comparison between the results of indirect and direct revascularization procedures. Neurosurgery. 1992;31(3):401\u2013405."},{"issue":"2","key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"260","article-title":"Standardized MR perfusion scoring system for evaluation of sequential perfusion changes and surgical outcome of moyamoya disease","volume":"40","author":"Lin YH","year":"2019","unstructured":"Lin YH, Kuo MF, Lu CJ, Standardized MR perfusion scoring system for evaluation of sequential perfusion changes and surgical outcome of moyamoya disease. AJNR Am J Neuroradiol. 2019;40(2):260\u2013266."},{"key":"b12","series-title":"World Neurosurg","first-page":"e697","article-title":"Characterizing revascularization after encephalo-duro-arterio-synangiosis (EDAS) in adult patients with moyamoya disease using the orbital grading system","volume":"191","author":"Alwakaa O","year":"2024","unstructured":"Alwakaa O, Enriquez-Marulanda A, Ramirez-Velandia F, Characterizing revascularization after encephalo-duro-arterio-synangiosis (EDAS) in adult patients with moyamoya disease using the orbital grading system. World Neurosurg. 2024;191:e697\u2013e706."},{"issue":"3","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"351","article-title":"Long-term clinical and radiographic outcomes after pial pericranial dural revascularization: a hybrid surgical technique for treatment of anterior cerebral territory ischemia in pediatric moyamoya disease","volume":"28","author":"Montaser A","year":"2021","unstructured":"Montaser A, Driscoll J, Smith H, Long-term clinical and radiographic outcomes after pial pericranial dural revascularization: a hybrid surgical technique for treatment of anterior cerebral territory ischemia in pediatric moyamoya disease. J Neurosurg Pediatr. 2021;28(3):351\u2013359."},{"issue":"6","key":"b14","series-title":"J Korean Neurosurg Soc","first-page":"415","article-title":"Moyamoya biomarkers","volume":"57","author":"Smith ER","year":"2015","unstructured":"Smith ER. Moyamoya biomarkers. J Korean Neurosurg Soc. 2015;57(6):415\u2013421."},{"key":"b15","series-title":"Front Neurol","first-page":"1115343","article-title":"Ultrasonic hemodynamic changes of superficial temporal artery graft in different angiogenesis outcomes of moyamoya disease patients treated with combined revascularization surgery","volume":"14","author":"Chen S","year":"2023","unstructured":"Chen S, Wang B, Wen Y, Ultrasonic hemodynamic changes of superficial temporal artery graft in different angiogenesis outcomes of moyamoya disease patients treated with combined revascularization surgery. Front Neurol. 2023;14:1115343."},{"issue":"11","key":"b16","series-title":"Eur Radiol","first-page":"8364","article-title":"Encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome: evaluation by computed tomography perfusion imaging","volume":"31","author":"Guo X","year":"2021","unstructured":"Guo X, Yuan X, Gao L, Encephaloduroarteriosynangiosis (EDAS) treatment of moyamoya syndrome: evaluation by computed tomography perfusion imaging. Eur Radiol. 2021;31(11):8364\u20138373."},{"issue":"4","key":"b17","series-title":"Acta Neurochir (Wien)","first-page":"377","article-title":"Efficacy of direct revascularization in adult moyamoya disease: haemodynamic evaluation by positron emission tomography","volume":"141","author":"Morimoto M","year":"1999","unstructured":"Morimoto M, Iwama T, Hashimoto N, Kojima A, Hayashida K. Efficacy of direct revascularization in adult moyamoya disease: haemodynamic evaluation by positron emission tomography. Acta Neurochir (Wien). 1999;141(4):377\u2013384."},{"issue":"4","key":"b18","series-title":"Pediatr Neurosurg","first-page":"143","article-title":"Axial magnetic resonance angiography in evaluating revascularization after indirect bypass surgery for moyamoya axial magnetic resonance angiography after indirect bypass","volume":"59","author":"Elbadry RG","year":"2024","unstructured":"Elbadry RG, Neuberger I, Ryan MV, Axial magnetic resonance angiography in evaluating revascularization after indirect bypass surgery for moyamoya axial magnetic resonance angiography after indirect bypass. 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