*Surgical Treatment of Moyamoya Disease DOI: http://dx.doi.org/10.5772/intechopen.99776*

vessel formation requires gentle dura handling and careful planning of any dural incisions.

Some have recommended medical treatment for asymptomatic MMD because it is associated with a 5.3% rate of clinical progression [97] unless they have reduced cerebral vascular reserve [97, 103, 214] or smoke [97, 215]. Most of these asymptomatic patients will undergo disease progression [103, 216]. When that happens, surgical BR is advisable [95, 103, 215].

In case of failure to initial BR, a new procedure, direct, indirect or combined, should be attempted, as good outcomes are common [166, 217].
