Objective To investigate the effect of revascularization on depression, anxiety and cerebral perfusion in adult patients with moyamoya disease, and analyze the correlation between depression, anxiety and cerebral perfusion. Methods Sixty-four consecutive adult patients with moyamoya disease admitted to our hospital from Jan. 2015 to Jun. 2016 were enrolled, including 42 cases receiving surgical treatment (16 cases in combined revascularization group and 26 cases in indirect revascularization group) and 22 cases receiving conservative treatment (conservation treatment group). Depression and anxiety were assessed by patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder-7-item (GAD-7) at admission, 6 months (±1 month) and 12 months (±1 month) after treatment. Cerebral perfusion was assessed by head computed tomography perfusion (CTP) at admission and 6 months (±1 month) after treatment. Analysis of variance and the least significant difference method were used to analyze the improvement of depression and anxiety and the changes of cerebral perfusion in each group. Pearson correlation analysis was used to analyze the correlation between the improvement of emotion and cerebral perfusion. Results There were no significant differences in gender, age, years of education, National Institutes of Health stroke scale (NIHSS) score, Fazekas score or stroke history at admission among the 3 groups (all P>0.05). Six months after surgery, the PHQ-9 and GAD-7 scores were decreased compared with those at admission in both combined and indirect revascularization groups (all P<0.05), while there were no significant differences in PHQ-9 or GAD-7 score between 12 months and 6 months after surgery in both groups (P>0.05). There was no significant difference in the improvement degrees of PHQ-9 and GAD-7 scores between the combined and indirect revascularization groups 6 months after surgery (P>0.05). The PHQ-9 and GAD-7 scores 6 and 12 months after surgery were similar with those at admission in the conservation treatment group (all P>0.05). Six months after surgery, the time to peak (TTP) was significantly decreased compared with those at admission in the combined and indirect revascularization groups (P=0.04 and 0.04), while the cerebral blood flow (CBF) was significantly increased (P=0.02 and 0.04). The improvement of PHQ-9 score was positively correlated with the improvement of TTP 6 months after surgery (r=0.62, P<0.01). Conclusion Revascularization can improve the depression and anxiety of adult patients with moyamoya disease. The effect of indirect revascularization and combined revascularization is similar. The surgery may improve the depression and anxiety by improving cerebral perfusion.