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Moyamoya disease is characterized by bilateral stenosis of the distal portion of the internal carotid artery and the proximal anterior and middle cerebral arteries
There is a compensatory formation of an abnormal network of perforating blood vessels providing collateral circulation.
So we have to take special care to avoid hypotension , hypovolemia ( give optimal preoperative, intraoperative and postoperative hydration) hyperthermia, and hypocarbia ( to avoid hypocarbia induced cerebral vasoconstriction)
Surgical Management of Moyamoya Syndrome Edward R. Smith, R. Michael Scott , Skull Base. 2005;15(1):15-26.