{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:38:15Z","timestamp":1770115095743,"version":"3.49.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"25","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,6,23]]},"abstract":"\n BACKGROUND<\/jats:title>\n Bilateral revascularization surgery is commonly performed in patients with bilateral moyamoya disease (MMD), even when ischemic symptoms or strokes are confined to one hemisphere. However, in select cases, a unilateral bypass may suffice to revascularize both hemispheres due to the development of post-revascularization pial collateral shift. This report aims to introduce the concept of pial collateral shift and presents 3 cases of bilateral MMD in which unilateral revascularization alone was deemed sufficient.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n Three adult patients with ischemic MMD exhibited bilateral type III vascular insufficiency on single-photon emission CT (SPECT) imaging after Diamox challenge. Each underwent unilateral revascularization of the symptomatic hemisphere. Postoperatively, cerebral angiography and SPECT with Diamox were performed. The angiograms revealed a phenomenon the authors term \u201cpial collateral shift,\u201d an adaptive redistribution of pial collateral flow following cerebral revascularization, specifically an increase in pial collateral flow toward the non-bypassed hemisphere in those 3 cases. Postoperative SPECT with Diamox demonstrated normalization of cerebrovascular reserve in both hemispheres, eliminating the need for contralateral revascularization.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Pial collateral shift observed on the postoperative angiogram suggests a fully augmentative bypass. Patients with bilateral MMD should be reassessed after the initial bypass, as bilateral revascularization may not be necessary in all cases.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25229<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25229","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T20:03:29Z","timestamp":1751313809000},"source":"Crossref","is-referenced-by-count":0,"title":["Pial collateral shift after unilateral bypass in bilateral moyamoya disease: illustrative cases"],"prefix":"10.3171","volume":"9","author":[{"given":"O\u2019Donnell","family":"Devon B.","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1121-6996","authenticated-orcid":true,"given":"Jonathan","family":"Rychen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra\/Northwell, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7257-3486","authenticated-orcid":true,"given":"Zoey","family":"Croft","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra\/Northwell, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyle H.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy G.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5325-1343","authenticated-orcid":true,"given":"Christian","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra\/Northwell, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason A.","family":"Ellis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lenox Hill Hospital, Zucker School of Medicine at Hofstra\/Northwell, Northwell Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Langer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"5","key":"bib1","series-title":"Stroke","first-page":"1415","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic Moyamoya disease: results of the Japan Adult moyamoya Trial","volume":"45","author":"Miyamoto","year":"2014","unstructured":"Miyamoto SYoshimoto THashimoto NEffects of extracranial-intracranial bypass for patients with hemorrhagic Moyamoya disease: results of the Japan Adult moyamoya Trial. Stroke. 2014;45(5):1415-1421."},{"issue":"1","key":"bib2","series-title":"Ann Neurol","first-page":"92","article-title":"Pediatric Moyamoya disease: an analysis of 410 consecutive cases","volume":"68","author":"Kim","year":"2010","unstructured":"Kim SKCho BKPhi JHPediatric Moyamoya disease: an analysis of 410 consecutive cases. Ann Neurol. 2010;68(1):92-101."},{"issue":"4","key":"bib3","series-title":"Neurol Med Chir (Tokyo)","first-page":"165","article-title":"2021 Japanese guidelines for the management of Moyamoya disease: guidelines from the research committee on Moyamoya disease and Japan stroke society","volume":"62","author":"Fujimura","year":"2022","unstructured":"Fujimura MTominaga TKuroda S2021 Japanese guidelines for the management of Moyamoya disease: guidelines from the research committee on Moyamoya disease and Japan stroke society. Neurol Med Chir (Tokyo). 2022;62(4):165-170."},{"issue":"1","key":"bib4","series-title":"Sci Rep","first-page":"8358","article-title":"Natural course of hemodynamically stable hemispheres contralateral to operated hemispheres in adult patients with ischemic moyamoya diseases","volume":"14","author":"Kang","year":"2024","unstructured":"Kang YSCho WSNam SMNatural course of hemodynamically stable hemispheres contralateral to operated hemispheres in adult patients with ischemic moyamoya diseases. Sci Rep. 2024;14(1):8358."},{"key":"bib5","series-title":"Int J Surg Case Rep","first-page":"15","article-title":"One sided bypass for bilateral Moyamoya disease, a case report and review of the literatures","volume":"22","author":"Li","year":"2016","unstructured":"Li XZhao NYang PZ.One sided bypass for bilateral Moyamoya disease, a case report and review of the literatures. Int J Surg Case Rep. 2016;22:15-18."},{"issue":"3","key":"bib6","series-title":"AJR Am J Roentgenol","first-page":"605","article-title":"The acetazolamide challenge: imaging techniques designed to evaluate cerebral blood flow reserve","volume":"153","author":"Rogg","year":"1989","unstructured":"Rogg JRutigliano MYonas HJohnson DWPentheny SLatchaw RE.The acetazolamide challenge: imaging techniques designed to evaluate cerebral blood flow reserve. AJR Am J Roentgenol. 1989;153(3):605-612."},{"issue":"5","key":"bib7","series-title":"AJNR Am J Neuroradiol","first-page":"876","article-title":"The acetazolamide challenge: techniques and applications in the evaluation of chronic cerebral ischemia","volume":"30","author":"Vagal","year":"2009","unstructured":"Vagal ASLeach JLFernandez-Ulloa MZuccarello M.The acetazolamide challenge: techniques and applications in the evaluation of chronic cerebral ischemia. AJNR Am J Neuroradiol. 2009;30(5):876-884."},{"issue":"3","key":"bib8","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","unstructured":"Suzuki JTakaku A.Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288-299."},{"issue":"7","key":"bib9","series-title":"Curr Treat Options Neurol","first-page":"22","article-title":"Surgical treatment of adult Moyamoya disease","volume":"20","author":"Lee","year":"2018","unstructured":"Lee SUOh CWKwon OKSurgical treatment of adult Moyamoya disease. Curr Treat Options Neurol. 2018;20(7):22."},{"issue":"3","key":"bib10","series-title":"Neurosurgery","first-page":"596","article-title":"Impact of cerebral revascularization on pial collateral flow in patients with unilateral Moyamoya disease using quantitative magnetic resonance angiography","volume":"95","author":"Santhumayor","year":"2024","unstructured":"Santhumayor BAWhite TGGolub DImpact of cerebral revascularization on pial collateral flow in patients with unilateral Moyamoya disease using quantitative magnetic resonance angiography. Neurosurgery. 2024;95(3):596-604."},{"key":"bib11","series-title":"World Neurosurg","first-page":"e1128","article-title":"Cerebral perfusion territory changes after direct revascularization surgery in Moyamoya disease: a territory arterial spin labeling study","volume":"122","author":"Yuan","year":"2019","unstructured":"Yuan JQu JZhang DCerebral perfusion territory changes after direct revascularization surgery in Moyamoya disease: a territory arterial spin labeling study. World Neurosurg. 2019;122:e1128-e1136."},{"key":"bib12","series-title":"NeuroImage Clin","first-page":"102684","article-title":"Contralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy","volume":"30","author":"Deckers","year":"2021","unstructured":"Deckers PTvan Hoek WKronenburg AContralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy. NeuroImage Clin. 2021;30:102684."},{"issue":"2","key":"bib13","series-title":"BMJ Open","first-page":"e006014","article-title":"Assessing the effect of unilateral cerebral revascularisation on the vascular reactivity of the non-intervened hemisphere: a retrospective observational study","volume":"5","author":"Sam","year":"2015","unstructured":"Sam KPoublanc JSobczyk OAssessing the effect of unilateral cerebral revascularisation on the vascular reactivity of the non-intervened hemisphere: a retrospective observational study. BMJ Open. 2015;5(2):e006014."},{"issue":"3","key":"bib14","series-title":"Neurosurg Rev","first-page":"347","article-title":"Contralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease","volume":"34","author":"Ma","year":"2011","unstructured":"Ma YLi MJiao LQZhang HQLing F.Contralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease. Neurosurg Rev. 2011;34(3):347-354."},{"issue":"1","key":"bib15","series-title":"Neurosurg Rev","first-page":"141","article-title":"A comment on \u201cContralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease","volume":"35","author":"Esposito","year":"2012","unstructured":"Esposito GFierstra JKronenburg ARegli L.A comment on \u201cContralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease.\u201d Neurosurg Rev. 2012;35(1):141-143."},{"issue":"5","key":"bib1","series-title":"Stroke","first-page":"1415","article-title":"Effects of extracranial-intracranial bypass for patients with hemorrhagic Moyamoya disease: results of the Japan Adult moyamoya Trial","volume":"45","author":"Miyamoto","year":"2014","unstructured":"Miyamoto SYoshimoto THashimoto NEffects of extracranial-intracranial bypass for patients with hemorrhagic Moyamoya disease: results of the Japan Adult moyamoya Trial. Stroke. 2014;45(5):1415-1421."},{"issue":"1","key":"bib2","series-title":"Ann Neurol","first-page":"92","article-title":"Pediatric Moyamoya disease: an analysis of 410 consecutive cases","volume":"68","author":"Kim","year":"2010","unstructured":"Kim SKCho BKPhi JHPediatric Moyamoya disease: an analysis of 410 consecutive cases. Ann Neurol. 2010;68(1):92-101."},{"issue":"4","key":"bib3","series-title":"Neurol Med Chir (Tokyo)","first-page":"165","article-title":"2021 Japanese guidelines for the management of Moyamoya disease: guidelines from the research committee on Moyamoya disease and Japan stroke society","volume":"62","author":"Fujimura","year":"2022","unstructured":"Fujimura MTominaga TKuroda S2021 Japanese guidelines for the management of Moyamoya disease: guidelines from the research committee on Moyamoya disease and Japan stroke society. Neurol Med Chir (Tokyo). 2022;62(4):165-170."},{"issue":"1","key":"bib4","series-title":"Sci Rep","first-page":"8358","article-title":"Natural course of hemodynamically stable hemispheres contralateral to operated hemispheres in adult patients with ischemic moyamoya diseases","volume":"14","author":"Kang","year":"2024","unstructured":"Kang YSCho WSNam SMNatural course of hemodynamically stable hemispheres contralateral to operated hemispheres in adult patients with ischemic moyamoya diseases. Sci Rep. 2024;14(1):8358."},{"key":"bib5","series-title":"Int J Surg Case Rep","first-page":"15","article-title":"One sided bypass for bilateral Moyamoya disease, a case report and review of the literatures","volume":"22","author":"Li","year":"2016","unstructured":"Li XZhao NYang PZ.One sided bypass for bilateral Moyamoya disease, a case report and review of the literatures. Int J Surg Case Rep. 2016;22:15-18."},{"issue":"3","key":"bib6","series-title":"AJR Am J Roentgenol","first-page":"605","article-title":"The acetazolamide challenge: imaging techniques designed to evaluate cerebral blood flow reserve","volume":"153","author":"Rogg","year":"1989","unstructured":"Rogg JRutigliano MYonas HJohnson DWPentheny SLatchaw RE.The acetazolamide challenge: imaging techniques designed to evaluate cerebral blood flow reserve. AJR Am J Roentgenol. 1989;153(3):605-612."},{"issue":"5","key":"bib7","series-title":"AJNR Am J Neuroradiol","first-page":"876","article-title":"The acetazolamide challenge: techniques and applications in the evaluation of chronic cerebral ischemia","volume":"30","author":"Vagal","year":"2009","unstructured":"Vagal ASLeach JLFernandez-Ulloa MZuccarello M.The acetazolamide challenge: techniques and applications in the evaluation of chronic cerebral ischemia. AJNR Am J Neuroradiol. 2009;30(5):876-884."},{"issue":"3","key":"bib8","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","unstructured":"Suzuki JTakaku A.Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in base of brain. Arch Neurol. 1969;20(3):288-299."},{"issue":"7","key":"bib9","series-title":"Curr Treat Options Neurol","first-page":"22","article-title":"Surgical treatment of adult Moyamoya disease","volume":"20","author":"Lee","year":"2018","unstructured":"Lee SUOh CWKwon OKSurgical treatment of adult Moyamoya disease. Curr Treat Options Neurol. 2018;20(7):22."},{"issue":"3","key":"bib10","series-title":"Neurosurgery","first-page":"596","article-title":"Impact of cerebral revascularization on pial collateral flow in patients with unilateral Moyamoya disease using quantitative magnetic resonance angiography","volume":"95","author":"Santhumayor","year":"2024","unstructured":"Santhumayor BAWhite TGGolub DImpact of cerebral revascularization on pial collateral flow in patients with unilateral Moyamoya disease using quantitative magnetic resonance angiography. Neurosurgery. 2024;95(3):596-604."},{"key":"bib11","series-title":"World Neurosurg","first-page":"e1128","article-title":"Cerebral perfusion territory changes after direct revascularization surgery in Moyamoya disease: a territory arterial spin labeling study","volume":"122","author":"Yuan","year":"2019","unstructured":"Yuan JQu JZhang DCerebral perfusion territory changes after direct revascularization surgery in Moyamoya disease: a territory arterial spin labeling study. World Neurosurg. 2019;122:e1128-e1136."},{"key":"bib12","series-title":"NeuroImage Clin","first-page":"102684","article-title":"Contralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy","volume":"30","author":"Deckers","year":"2021","unstructured":"Deckers PTvan Hoek WKronenburg AContralateral improvement of cerebrovascular reactivity and TIA frequency after unilateral revascularization surgery in moyamoya vasculopathy. NeuroImage Clin. 2021;30:102684."},{"issue":"2","key":"bib13","series-title":"BMJ Open","first-page":"e006014","article-title":"Assessing the effect of unilateral cerebral revascularisation on the vascular reactivity of the non-intervened hemisphere: a retrospective observational study","volume":"5","author":"Sam","year":"2015","unstructured":"Sam KPoublanc JSobczyk OAssessing the effect of unilateral cerebral revascularisation on the vascular reactivity of the non-intervened hemisphere: a retrospective observational study. BMJ Open. 2015;5(2):e006014."},{"issue":"3","key":"bib14","series-title":"Neurosurg Rev","first-page":"347","article-title":"Contralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease","volume":"34","author":"Ma","year":"2011","unstructured":"Ma YLi MJiao LQZhang HQLing F.Contralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease. Neurosurg Rev. 2011;34(3):347-354."},{"issue":"1","key":"bib15","series-title":"Neurosurg Rev","first-page":"141","article-title":"A comment on \u201cContralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease","volume":"35","author":"Esposito","year":"2012","unstructured":"Esposito GFierstra JKronenburg ARegli L.A comment on \u201cContralateral cerebral hemodynamic changes after unilateral direct revascularization in patients with Moyamoya disease.\u201d Neurosurg Rev. 2012;35(1):141-143."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/25\/article-CASE25229.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/25\/article-CASE25229.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/25\/article-CASE25229.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:40:57Z","timestamp":1770075657000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/25\/article-CASE25229.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":30,"journal-issue":{"issue":"25"},"URL":"https:\/\/doi.org\/10.3171\/case25229","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]}}}