LAUSR

LETTER: The article by Cheung et al. 1 entitled “Surgical outcome for moyamoya disease: clinical and perfusion computed tomography correlation” published in your esteemed journal was read with great interest. The authors investigated the clinical outcome of surgical interventions in patients with moyamoya disease in relation to age-group, clinical characteristic, and methods of surgical intervention with effect on cerebral blood flow and cerebrovascular reserve capacity of the middle cerebral artery (MCA) territory based on study of serial brain computed tomography perfusion scan imaging in the postoperative period and follow-up; changes were compared between the 23 intervention cases and 9 noninterventional cerebral hemispheres. Improvement in the cerebrovascular reserve capacity was greater in the bypass group compared with the synangiosis procedure group. However, the authors advise caution because the decision to carry out a surgical bypass procedure is to be balanced with the potential for relative risk for neurologic deterioration during the postoperative phase. The cerebral hemispheres on the nonsurgical intervention side also seem to benefit from revascularization surgery of the contralateral cerebral hemispheres.