Intradural arteriosynangiosis in pediatric moyamoya disease: modified technique of encephalo-duro-arterio-synangiosis with reduced operative damage to already growing revascularization.
OBJECTIVE
Various operative procedures have been described for the treatment of pediatric moyamoya disease. However, the majority of invasive or radical procedures proposed have focused primarily on revascularization and few have discussed to maximizing preservation of the already growing neovascular network.


METHODS
This present procedure describes the supratemporal artery is anastomosed to the inner layer of the dura mater and surrounded by the outer layer as a sandwich with a blunt procedure of dural layer separation.


RESULTS
This technique efficiently established an anastomotic connection between the supratemporal artery and the cortical brain, and the dura mater postoperatively with maximally preserving the existing vascular network.


CONCLUSIONS
IDAS, the modified surgical technique of EDAS, shall be benefit in preserving the already developed collateral circulation, and underlying structure over the brain cortex as much as possible, which is important particularly in pediatric moyamoya patients.
Muto
Jun
J
Department of Neurosurgery, Keio University, School of Medicine, Tokyo, Japan.
Oi
Shizuo
S
D002339:Carotid Arteries / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D004388:Dura Mater / Q000098:blood supply*; D005260:Female; D006801:Humans; D009072:Moyamoya Disease / Q000503:physiopathology / Q000601:surgery*; D010372:Pediatrics; D011183:Postoperative Complications; D013699:Temporal Arteries / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome