Combined direct anastomosis and encephaloduroarteriogaleosynangiosis using inverted superficial temporal artery-galeal flap and superficial temporal artery-galeal pedicle in adult moyamoya disease.
BACKGROUND
We evaluated the efficacy of combined STA-MCA anastomosis and EDAGS using inverted STAGF and STAGP for the treatment of adult MMD.


METHODS
This study included 8 patients with nonhemorrhagic MMD. There were 6 women and 2 men who were between 23 and 62 years old (mean = 37.8 years) in the sample. The combined surgery was performed on 12 sides in the 8 patients. The surgical results were assessed for clinical outcome, angiographic revascularization, and hemodynamic change on HMPAO brain SPECT. The follow-up period ranged from 6 to 62 months (mean = 27 months).


RESULTS
Clinical symptoms and signs were improved or stabilized, and the extent of revascularization evident on external carotid angiograms was excellent in all 8 patients. The CBF on HMPAO SPECT also improved in all 12 sides that were operated on with the combined surgery, except for the preexisting infarcted area, on the basal as well as Diamox stimulation studies. One patient had a transient speech disturbance after surgery, and another patient had delayed wound healing.


CONCLUSIONS
The combined STA-MCA anastomosis and EDAGS using inverted STAGF/P seems to be one of the most effective surgical modalities for the treatment of nonhemorrhagic MMD in adults.
Kim
Dal-Soo
DS
Department of Neurosurgery, The Catholic University of Korea College of Medicine, Uijeongbu St Mary's Hospital, Uijeongbu, Gyeonggi 480-130, South Korea.
Yoo
Do-Sung
DS
Huh
Pil-Woo
PW
Kang
Seok-Gu
SG
Cho
Kyoung Suok
KS
Kim
Moon-Chan
MC
D000328:Adult; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D004388:Dura Mater / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009072:Moyamoya Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011877:Radionuclide Imaging; D012535:Scalp / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply* / Q000502:physiology; D013687:Telencephalon / Q000098:blood supply / Q000000981:diagnostic imaging / Q000503:physiopathology; D013699:Temporal Arteries / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D016896:Treatment Outcome