REVASCULARIZATION WITH SPLIT DURO-ENCEPHALO-SYNANGIOSIS IN THE PEDIATRIC MOYAMOYA-DISEASE - SURGICAL RESULT AND CLINICAL OUTCOME

Dural arteries are potential donor arteries for cortical revasculariza tion. In this report, a technique of indirect anastomosis using a spli t dura is presented. At surgery, the dura near the branches of the mid dle meningeal artery was split into outer and inner layers, and the sp lit surface of the outer layer was attached to the cortical surface (s plit duro-encephalo-synangiosis; split DES). This procedure, combined with standard encephalo-duro-arterio-synangiosis, was applied to 25 he mispheres in 18 patients with pediatric Moyamoya disease (mean age, 6 years). Postoperative superselective angiograms demonstrated effective cortical revascularization through the dural arteries in addition to the supply from the scalp arteries. All the patients were symptom free by 1.5 years after surgery. Postoperative reversible ischemic neurolo gical deficit and infarction were seen in three (12%) and one (4%), re spectively. The follow-up period ranged from 1 to 12 years (mean, 6.5 years). Thirteen of 16 (81%) patients led normal lives and three were mildly handicapped due to mental retardation that existed preoperative ly. The split DES is a useful technique to extend the area of revascul arization of ischemic hemispheres in Moyamoya disease. (C) 1997 Elsevi er Science B.V.