Japan Adult Moyamoya (JAM) trial for the hemorrhagic adult moyamoya patients It is generally accepted that bypass surgery is effective for the moyamoya patients with ischemic presentation. However, it has not been proven that the bypass surgery is effective for the moyamoya patients with hemorrhagic presentation. In this situation, the purpose of treatment is the prevention of the recurrent hemorrhage. The recurrent hemorrhage is known to cause severe neurological deficits or occasionally fatal. Randomized, double blinded study started in Japan since January 2001. In order to examine the efficacy of the bypass surgery for the moyamoya patients with hemorrhagic presentation. Two groups are designed: "the best medical treatment" and "best medical treatment and bypass surgery". Inclusion criteria are as follows: 1. the moyamoya patients with hemorrhagic presentation (intracerebral hemorrhage, intraventricular hemorrhage, and subarachnoid hemorrhage which occurred within one year). 2. the patients are independent in their daily lives. 3. their ages are between 18 and 60 years old. Surgical methods must include the direct bypass surgery bilaterally and the patients should not be prescribed essentially with anti-platelet drugs or anticoagulants. Expected number of the patients in each group is 80 in the coming 5 years, thus total number of the patients is 160. As the country with the most number of moyamoya patients in the world, Japanese neurosurgeons are ready to answer the question on the efficacy of the bypass surgery for the hemorrhagic moyamoya disease. At present, nobody knows the final conclusion of the efficacy of the bypass surgery.