Combined direct and indirect reconstructive vascular surgery on the fronto-parieto-occipital region in Moyamoya disease

Between January 1992 and December 1995, eight patients with Moyamoya disease, aged from 2 to 39 years, underwent encephalo-duro-arterio-myo-synangiosis (EDAMS) on the frontal region, superficial temporal artery to middle cerebral artery (STA–MCA) anastomosis combined with encephalo-myo-synangiosis (EMS) on the parietal region and encephaloduro-arterio-synangiosis (EDAS) on the occipital region using the frontal and parietal branch of the STA and the occipital artery, respectively. The development of postoperative collateral formation was assessed by carotid angiography and the improvement of clinical symptoms was evaluated for over 1 year after the bypass surgery. Of the 13 sides which underwent EDAMS and STA–MCA anastomosis with EMS, 11 sides resulted in extensive revascularization on the frontoparietal region and two sides showed localized collaterals, whereas EDAS on the occipital region demonstrated extensive and localized revascularization in each four sides and no evidence of revascularization in two sides among ten sides which underwent the EDAS. The clinical improvement due to the combined reconstructive surgery was very excellent in the reduction of the incidence of transient ischemic attacks (TIA) and reversible ischemic neurologic deficits (RIND).