REVIEW
Doença de Moyamoya (DMM) é uma arteriopatia cerebrovascular progressiva caracterizada por estenose da artéria carótida interna e seus ramos, associada à formação de circulação colateral anômala. Apresenta distribuição etária bimodal, com maior prevalência em populações do Leste Asiático e risco variável entre grupos populacionais. O manejo clínico visa reduzir eventos isquêmicos e hemorrágicos, enquanto a revascularização cirúrgica constitui a principal estratégia terapêutica. Este estudo objetiva analisar criticamente as evidências sobre revascularização direta e indireta, bem como abordagens menos invasivas, avaliando benefícios funcionais, riscos, limitações e perspectivas futuras em neurocirurgia. Foram revisados estudos clínicos recentes e revisões sobre bypass direto (ATC-ACM, AO-ACM e enxertos) e indireto (EDAS, EMS, EAS, EDS, EMAS). Os desfechos incluíram perfusão cerebral, eventos isquêmicos/hemorrágicos, desenvolvimento de colaterais, função neurológica (escala de Rankin modificada) e complicações perioperatórias, com ênfase em síndrome de hiperperfusão cerebral. O bypass direto oferece restauração imediata do fluxo e melhora funcional precoce, tornando-o preferível em adultos com alto risco de isquemia. O bypass indireto, menos invasivo, promove angiogênese gradual e maior segurança em crianças. Abordagens híbridas e técnicas minimamente invasivas emergem como alternativas promissoras. A seleção do procedimento deve ser individualizada, considerando idade, anatomia vascular e risco clínico.
Moyamoya disease (MMD) is a progressive cerebrovascular arteriopathy characterized by stenosis of the internal carotid artery and its branches, associated with the formation of anomalous collateral circulation. It presents a bimodal age distribution, with a higher prevalence in East Asian populations and variable risk among population groups. Clinical management aims to reduce ischemic and hemorrhagic events, while surgical revascularization constitutes the main therapeutic strategy. This study aims to critically analyze the evidence on direct and indirect revascularization, as well as less invasive approaches, evaluating functional benefits, risks, limitations, and future perspectives in neurosurgery. Recent clinical studies and reviews on direct (STA-MCA, OA-MCA and grafts) and indirect (EDAS, EMS, EAS, EDS, EMAS) bypass were reviewed. Outcomes included cerebral perfusion, ischemic/hemorrhagic events, collateral development, neurological function (mRS), and perioperative complications, with emphasis on cerebral hyperperfusion syndrome. Direct bypass offers immediate restoration of flow and early functional improvement, making it preferable in adults with a high risk of ischemia. Indirect bypass, which is less invasive, promotes gradual angiogenesis and greater safety in children. Hybrid approaches and minimally invasive techniques are emerging as promising alternatives. The selection of the procedure should be individualized, considering age, vascular anatomy, and clinical risk.
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1Centro Universitário Aparício Carvalho – FIMCA, Porto Velho, RO, Brasil.
2Chief of Vascular Neurosurgery Department, Instituto de Neurologia de Curitiba – INC, Curitiba, PR, Brasil.
Received Jan 6, 2026
Corrected Jan 22, 2026
Accepted Mar 21, 2026
