• Joham Choque-Velasquez, Roberto Colasanti, Danil A Kozyrev, Juha Hernesniemi, and Akitsugu Kawashima.
• Neurosurgical Unit, Es-Salud Trujillo Hospital, La Libertad, Peru; Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: johchove@hotmail.com.
• World Neurosurg. 2017 Dec 1; 108: 50-53.

BackgroundPediatric moyamoya cases may be very arduous, even more so in a developing country, where access to specialized centers may be prevented by different factors.Case DescriptionHerein we report a challenging case, which was managed in the new Neurosurgical Center of Trujillo, regarding the direct anastomosis between the left superficial temporal artery and a cortical branch of the left middle cerebral artery in a 8-year-old Peruvian boy with moyamoya disease. Postoperatively, the patient's motor deficits and aphasia improved. To the best of our knowledge, this is the first performance of a direct revascularization for a pediatric moyamoya case in Peru.ConclusionsThe creation of highly specialized neurosurgical centers in the main strategic places of developing countries may allow optimal treatment of neurosurgical patients with complex diseases.Copyright © 2017 Elsevier Inc. All rights reserved.

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