Introduction –Moya Moya syndrome can have progressive course requiring surgical intervention in many children. We report our experience of managing a cohort of surgically managed children

Methods -Prospectively maintained data of children with surgically treated Moyamoya between  2015-2018. Demographic, disease-specific, and radiographic data reviewed with the latest follow up and imaging. Perform direct revascularization (STA-MCA bypass) for most patients. Children with very small recipient vessels – EDAMS. Imaging follow-up consisted with one of standard procedures

Results 14 Children, 24 hemispheres,

Age - 5months to 12 years, 2 with familial Moya Moya  and one with NF1 Duration from last symptom to surgery -  3days to 40 days. Stroke 11, Seizures in 3, TIA 2, Headache in 2. MRI was done in all. Ten bilateral and 4 unilateral,  total 24 procedures, 16 direct and 8 indirect revascularization procedures.  Angiographic outcome did not statistically correlate with type of anastomosis. Excellent postoperative revascularization showed a trend occurring in children with relatively milder clinical presentation.

NO  mortality and 2 had postoperative strokes in early post operative period and 1  had recurrent TIA on previous operated side

Two had superficial wound healing issues and one pseudomenigocele with csf leak. No revision revascularization procedures. Follow up  - 2months  to 2 years.

Conclusion –Long term surgical outcomes were good  in all children except an infant with onset of recurrent strokes at 1 month of age. Early aggressive management provides best long term outcome.