Which Is Better for Moyamoya Disease: Conservative Treatment or Surgery?

Many people occasionally experience symptoms like dizziness and headaches, often dismissing them as fatigue or lack of sleep. However, when these symptoms persist and worsen over time, a thorough medical examination may reveal a more serious underlying condition—Moyamoya disease. This rare cerebrovascular disorder affects blood flow to the brain and can lead to a range of neurological issues, including impaired motor function, speech difficulties, vision loss, and in severe cases, stroke or cerebral hemorrhage if left untreated.

Understanding Moyamoya Disease

Moyamoya disease is not a minor health concern—it's a progressive disorder characterized by the narrowing or blockage of major arteries at the base of the brain, particularly the internal carotid arteries. As these vessels become increasingly constricted, the brain struggles to receive adequate oxygenated blood. In response, the body forms tiny collateral blood vessels that appear "smoky" on imaging scans—hence the name "Moyamoya," which means "puff of smoke" in Japanese.

Why Conservative Treatment Falls Short

Some patients wonder whether medication and lifestyle adjustments (conservative treatment) are sufficient for managing Moyamoya disease. While drugs such as antiplatelets may help reduce the risk of clot formation, they do not address the root cause: the structural abnormalities in the cerebral vasculature. Over time, conservative approaches cannot prevent the progression of arterial stenosis or reverse existing damage. Therefore, their long-term effectiveness is limited, especially in moderate to severe cases.

The Role of Surgical Intervention

Surgical revascularization has emerged as the gold standard for treating Moyamoya disease. Unlike conservative methods, surgery directly improves cerebral blood flow by creating new pathways for oxygen-rich blood to reach the brain. This significantly reduces the risk of ischemic stroke, hemorrhage, and other life-threatening complications.

Types of Revascularization Procedures

Direct bypass surgery, such as encephaloduroarteriosynangiosis (EDAS) or superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis, connects a healthy extracranial artery to a vessel within the brain. Indirect techniques involve placing vascularized tissues onto the brain surface to encourage the growth of new blood vessels over time. Often, a combination of both direct and indirect methods—known as combined bypass surgery—offers the most robust and lasting improvement in cerebral perfusion.

Proven Clinical Outcomes

Multiple studies have demonstrated that surgical intervention leads to better neurological outcomes and a marked decrease in stroke incidence among Moyamoya patients. Post-surgery, many individuals report reduced frequency of headaches, improved cognitive function, and enhanced quality of life. Early diagnosis followed by timely surgery is key to preventing irreversible brain damage.

In conclusion, while conservative management may provide temporary symptom relief, it does not alter the disease's progression. For lasting protection and optimal recovery, surgical revascularization remains the most effective treatment strategy for Moyamoya disease. Patients diagnosed with this condition should consult a neurovascular specialist to evaluate their eligibility for surgery and develop a personalized care plan.