Encephalo-omental synangiosis in the management of moyamoya disease.
Moyamoya disease is a chronic occlusive cerebrovascular disorder characterized by stenosis of the intracranial internal carotid artery often accompanied by stenosis of the anterior and/or middle cerebral arteries. This results in cerebral ischemia, which manifests clinically as transient, repetitive episodes of hemiplegia, dysarthria, and involuntary movements. This case report documents a patient in whom an initial extracranial-intracranial bypass (superficial temporal-middle cerebral artery) failed to alleviate the ischemic symptoms. In a subsequent procedure, a pedicle graft of omentum was created and through a subcutaneous tunnel was placed on the right cerebral cortex. Over a 2 1/2-year period, this has resulted in a dramatic resolution of the patient's symptomatology. The report delineates the condition and reviews other therapeutic options.
Havlik
R J
RJ
Department of Surgery, Yale University School of Medicine, New Haven, CT 06510.
Fried
I
I
Chyatte
D
D
Modlin
I M
IM
D000328:Adult; D000714:Anastomosis, Surgical; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000601:surgery*; D002540:Cerebral Cortex; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation; D006801:Humans; D008297:Male; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D009852:Omentum / Q000637:transplantation*; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation; D013524:Surgical Flaps