Special Considerations: Elderly

Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease with unknown etiology characterized by progressive stenosis/occlusion at the terminal portion of the internal carotid artery and an abnormal vascular network formation at the base of the brain. MMD was known to have bimodal age distribution with a peak each in childhood and young adulthood, and presentation in the elderly has been considered to be relatively rare. Recently, there is an increasing number of the elderly patients being diagnosed as having MMD and undergoing management under the modern diagnostic criteria, which also includes patients with atherosclerosis and/or with unilateral involvement as the definitive MMD. The aim of this chapter is to summarize the current status of revascularization surgery for elderly MMD patients. We also introduce the tips and pitfall of the diagnosis and the management of elderly MMD patients.