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The recent progress of neuroendoscopy and exoscopy has yielded new strategies in neurosurgery, especially in glioma surgery. Neuroendoscopic port surgery makes it possible to remove deep-seated gliomas with minimal invasiveness. In port surgery, it is important to control tumor bleeding during intratumoral removal. As exoscopic systems have high flexibility of the video camera position, the surgical approach can be selected with various visual axes, which is difficult when using microscopic systems. Considering the characteristics of exoscopes, exoscopic surgery can be applied for the removal of superficial gliomas, and exoscopes are useful for glioma resection under awake craniotomy. However, there are outstanding tasks to improve surgical devices for neuroendoscopic surgery. The video quality and deep lighting of exoscopes are insufficient for general usage. Moreover, there are few training courses available for these surgical techniques. In the near future, based on these developments, neuroendoscopic and exoscopic surgeries may become more common treatments.

Here, we report three cases of moyamoya disease with a history of Kawasaki disease. A 33-year-old man was found to have stenotic lesions of the internal carotid arteries(ICAs)on both sides at a nearby hospital where he visited complaining of headache and lisping. He had received immunoglobulin therapy for Kawasaki disease at the ages of 1, 2, and 6 years. MRI showed only a chronic ischemic lesion in the white matter. Angiography showed occlusion at the terminal portion of the ICAs on both sides. He was diagnosed with moyamoya disease, but as he had no symptoms and preserved cerebral blood flow (CBF), he was kept under observation. An 8-year-old boy was diagnosed with moyamoya disease and underwent right encephaloduroarteriosynangiosis at a nearby hospital. He had received immunoglobulin therapy for Kawasaki disease at the age of 1 year. His ischemic symptoms worsened. Although MRI detected no apparent ischemic lesion, angiography revealed severe stenosis at the terminal portions of the ICAs on both sides, and 123I-IMP SPECT showed CBF impairment. Bilateral direct bypass was performed. His father was subsequently also diagnosed with moyamoya disease. A 4-year-old girl with epilepsy was diagnosed with moyamoya disease at a nearby hospital. She had been treated with aspirin for Kawasaki disease at the age of 1 year. MRI detected no remarkable ischemic lesions, but angiography revealed mild stenosis at the terminal portions of the ICAs on both sides. Five months later, her ischemic symptoms were worsening with progressing stenotic lesions, and she underwent bilateral direct bypass.