Аннотация:Objective: Evaluation of the results of combined brain revascularization in patients with moyamoya disease with analysis of the clinical picture and perfusion and angiographic features of neoangiogenesis.Background. Combined brain revascularization is recognized as the most appropriate treatment for patients with moyamoya disease worldwide. However, despite the large number of previous studies, the optimal techniques of combined revascularization are still unclear.Methods. For the period from 2013 to 2020 in the Burdenko Center of Neurosurgery 79 combined revascularizations were performed in 55 patients with moyamoya disease. The average age of the patients was 13.9 ± 10.11 years. All patients were examined according to a single diagnostic protocol, including a comprehensive assessment of the state of brain tissue, cerebral vascular system and cerebral blood flow. The results of surgical treatment were assessed in the early postoperative and long-term periods. The average follow-up period was 14.66 ± 13.17 months. In the postoperative period, the dynamics of neurological status and cerebral blood flow were assessed, and the features of neoangiogenesis from various components of revascularization were studied.Results. In the early postoperative period, in 77.2% of cases, a good treatment result was observed with no negative dynamics of the neurological status. Ischemic stroke in the operated hemisphere developed in 4 cases (5.1%). In the long-term postoperative period, an improvement in focal and cerebral neurological symptoms was observed in 76.6%. Improvement of cerebral blood flow was noted in 92.4% of cases, direct bypasses functioned in 94.3%, and signs of neovascularization in the area of indirect synangiosis were observed in 80.0%. At the same time, a complementary influence of direct and indirect components of revascularization was revealed in ensuring good general angiographic and perfusion results of surgical treatment.Conclusions. Combined revascularization is a highly effective method of surgical treatment of all patients with moyamoya disease with justified use of both direct and indirect components.