Journal
NEUROLOGIA MEDICO-CHIRURGICA
Volume 46, Issue 9, Pages 462-467Publisher
JAPAN NEUROSURGICAL SOC
DOI: 10.2176/nmc.46.462
Keywords
moyamoya disease; superficial temporal artery-anterior cerebral artery bypass; encephalo-galeo-arterio-synangiosis; anterior cerebral artery; intellectual outcome
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Some patients with moyamoya disease treated by conventional surgical procedures may develop postoperative refractory ischemia and perioperative cerebral infarction in the anterior cerebral artery (ACA) territory. We present a novel operative procedure for moyamoya disease to avoid the risk of ischemia in the ACA territory, which consists of simultaneous superficial temporal artery (STA) to middle cerebral artery (MCA) or ACA bypass with pan-synangiosis, encephalo-duro-arterio-myosynangiosis for the lateral frontal and temporal areas, and encephalo-galeo-arterio-synangiosis for the medial frontal area. This procedure can establish direct bypass to the ACA territory at the first intervention. Simultaneous STA-MCA and STA-ACA bypasses with pan-synangiosis is suitable for patients with moyamoya disease associated with severely impaired perfusion of the ACA territory requiring direct bypass surgery.
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