Well our first visit to the neurosurgeon 1st April here in DC suggested waiting 6 months and repeating the MRA on our 12 yr old son, who is asymptomatic of Moyamoya (its was picked up on MRI for his NF1 check).  However I sensed (the mum or nurse in me) that he was glossing over some of my very specific questions IE how severe were Oliver's vessels damaged.  He just kept saying "well there is no evidence of ischemia".  He was happy for us to get a second opinion, so after reading this great web support page I contacted Stanford Moyamoya clinic and fed ex'ed his reports by the Friday and by Tuesday 10am I had a call....that has put me in a spin.
Dr Steinberg's team have assessed Oliver's results and found a complete blockage of his Middle cerebral artery right side and seemed to be surprised he has never had any symptoms. He is recommending a "Combined direct and indirect revascularization procedure" in the summer holidays. 
My question is has anyones child been through this "combined" procedure and how did their children respond? 
Once again many thanks for your great information.  I could not believe how quickly they got back to us with a second opinion, just brilliant! 
Now it is a paperwork game getting our Australian Embassy to pay for it all, as we are here in the USA on a 3 year military posting.  I'm praying they don't send us home to have the surgery, when the top specialist are within reach in this country.

Many thanks for that Dr's information I will keep it for possible future use.  Unfortunately Perth is on the West Coast of Australia and we call our home town Brisbane, Queensland (East Coast). But I have found from this web page a specialist on the East Coast in Sydney. 
I am still hoping that as we are here for another 2+ years in Washington DC, we will be able to have the surgery with Dr Steinberg at Stanford.
But you have given me an idea to contact Dr Steinberg's rooms back and ask if they know any Moyamoya specialist in our home state in Australia, in case the Embassy request that we fly home for the surgery. I'm sure there is a close medical fraternity with such a rare disease.
Cheers.

Thanks Margaret for the clarification and lovely welcome.  I have been so impressed with the speed at which the Stanford Moyamoya clinic staff have got back to us with forms, costings and reports to send into the Embassy.  I have had all the required paperwork done within one week!  Meanwhile I am still waiting for a written letter from the initial Neurosurgeon we saw here in DC on 1st April. I should know back from the Defence Health Team in Australia within 10 days whether they approve the surgery in California.  Fingers crossed. I'll post when I know more.

Excellent, thank you. I will keep those Doctors names on file as we will need follow up as well when we are back in Oz. Good to know we have some experienced Moyamoya specialists as well.  My husband knows Melbourne well so I will google that Dr. Cheers.

I'm happy to hear that you have a plan.  How is your son handling his diagnosis and upcoming surgery plans?

Thank you Maryanne, I have just read about Professor Stoodley and if it comes to surgery in Australia, I will probably go his direction as it is closer to Brisbane for my family to travel to. Still waiting on word from Defense...any day now!

Well the wait is finally over as we got an email late last night giving approval for us to have our son's surgery here in the USA.
I am just organising a phone chat with Dr. Steinberg to answer a few concerns we have, but am leaning Stanford way.  I have also had excellent conversations with Dr. Ed. Smith at Boston MM clinic, and both MM clinic techniques whilst different sound equally successful. However Stanford's comprehensive pre and post op follow up, especially with the cognitive testing (which for my son who has executive functioning difficulties) I feel we will be able to monitor his progress a little more closely in this area.
Thank you all for your thoughts and guidance to date.
Surgery will probably take place July 18. I'll keep you posted. Cheers.