What are the current knowledge gaps in the understanding of moyamoya disease?
Significant knowledge gaps exist in our understanding of moyamoya disease. No prospective RCT exists comparing medical management with surgical intervention for either the primary or secondary prevention of ischemic events in patients with moyamoya disease. Similarly, there are no prospective RCTs comparing the efficacy of the most common surgical revascularization procedures used for the prevention of ischemic events in this patient population. Numerous obstacles to the performance of such trials exist, including a lack of equipoise among many treating neurologists and neurosurgeons, particularly for symptomatic patients. Consideration should therefore also be given to comprehensive, adjudicated long-term registries as an alternative means of investigation.