Comprehensive data on the optimal treatment of and outcomes in pediatric moyamoya in the US is lacking. Titsworth et al. assessed a total of 2454 moyamoya admissions from 1997 to 2012 in the Kids Inpatient Database. The authors found that the care of moyamoya patients has been concentrating at high-volume centers during the past 12 years. Among moyamoya admission without surgical revascularization, high-volume hospitals show no difference in length of stay, cost, or complications compared with low-volume centers. However, low-volume hospitals have more nonroutine discharges and inpatient deaths when no revascularization was performed. In contrast, among admissions with surgical revascularization, high-volume centers had decreased length of stay, reduced cost, and no increase in complications compared with low-volume centers. Admissions with revascularization to low-volume hospitals also had increased likelihood of nonroutine discharge (compared with high-volume centers. In the largest study of US pediatric moyamoya admissions to date, the authors found that volume correlates with outcome, indicating high-volume centers provide significantly improved care and reduced mortality in pediatric moyamoya patients, with the most marked benefit observed in admissions for surgical revascularization.