Superficial temporal artery-to-middle cerebral artery anastomosis with encephalo-duro-myo-synangiosis as a modified operative procedure for moyamoya disease.
BACKGROUND
Various types of revascularization surgery have been performed for moyamoya disease. Although the efficacies of these operations are well recognized, the optimal operative procedure remains undecided. In this report, we describe our modified surgical revascularization procedure for moyamoya disease and retrospectively analyze the results of such surgeries on six sides in six adult patients.


METHODS
Our operative procedure, combining direct and indirect bypasses, is a superficial temporal artery to middle cerebral artery anastomosis with encephalo-duro-myo-synangiosis. The encephalo-duro-myo-synangiosis is an indirect bypass combining the encephalo-duro- and encephalo-myo-synangioses. This operative procedure has been used routinely in adult patients since 2002.


RESULTS
Perioperative complications were noted in one of the six operations. This complication was transient and no attributive lesions were detected on CT or MRI. Revascularization was seen in cerebral blood flow studies in all patients, and the clinical outcomes were excellent or good. Effective neovascularization through the grafts was observed in all patients in follow-up angiographies.


CONCLUSIONS
This operative procedure provides needed revascularization and prevents ischemic deficits. This modified procedure is useful for responding to subsequent additional ischemia in the area of the anterior cerebral artery and should be considered one of the optimal procedures for treating moyamoya disease.
Ishii
Keisuke
K
Department of Neurosurgery, Oita University School of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan. keisuke@med.oita-u.ac.jp
Morishige
Masaki
M
Anan
Mitsuhiro
M
Sugita
Kenji
K
Abe
Eiji
E
Kubo
Takeshi
T
Fujiki
Minoru
M
Kobayashi
Hidenori
H
D000328:Adult; D001163:Arteriovenous Anastomosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D002548:Cerebral Revascularization / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D009072:Moyamoya Disease / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D015899:Tomography, Emission-Computed, Single-Photon / Q000295:instrumentation; D016896:Treatment Outcome; D055815:Young Adult