**5. Conclusion**

Moyamoya disease (MMD) is a unique, slowly progressive cerebral vasculopathy with an incidence of 0.09–10/100,000 individuals. It is highly prevalent in East Asia. It has an unknown etiology and classically presents with symptoms of headaches, transient ischemic attacks such as dysarthria, hemiparesis, cognitive decline, aphasia, and seizures. Early diagnosis and early treatment are effective in preventing further deterioration. Medical treatment is aimed at managing symptoms and typically includes anti-seizure, antihypertensive, and antiplatelet therapy. Surgical revascularization is the cornerstone in treating MMD patients to reduce further ischemic insults and neurological deterioration. Its unique pathophysiology requires anesthesiologists to strategize an individualized anesthetic plan and closein line communications with the neurosurgical team. Premedication is essential in pediatric patients undergoing revascularization surgery as the goal is to avoid crying and hyperventilation which provokes cerebral vasoconstriction. Perioperative management of moyamoya disease has a direct influence on the outcomes of the surgery. The key goals of perioperative management are maintenance of normotension, normovolaemia, normocapnia and normothermia, and adequate analgesia. Postoperatively, patients are admitted to the intensive care unit for close hemodynamic assessment and timely neurological assessment. Effective analgesia and fluid resuscitation must be employed postoperatively. Antiepileptic drugs are continued perioperatively, and antiplatelet agents are started postoperatively.
