Pediatric CPA often manifests with ischemia and diffuse, eloquent-intermixed vasculature. In symptomatic children with hypoperfusion, indirect revascularization is a reasonable strategy to enhance perfusion and reduce recurrent ischemic events. Aggregated evidence and our illustrative case suggest robust and durable outcomes following pial-based indirect bypass, supporting early multidisciplinary evaluation and individualized surgical consideration.
Moskalik et al. (2026) studied this question.