Moyamoya disease: no need for anastomotic surgery?

This paper describes an Australian of Caucasian descent with severe Moyamoya disease. She presented at the age of 34 with a subarachnoid haemorrhage. Between the ages of 45 and 48 she had multiple episodes of cerebrovascular ischaemia. Anastomotic surgery was carefully considered but not undertaken. Ten year follow up showed her to be extremely well without any further episodes of cerebrovascular disease. Accordingly it is recommended that surgery is probably not necessary in some cases, particularly in adults