DIRECT AND INDIRECT REVASCULARIZATION FOR MOYAMOYA-DISEASE SURGICAL TECHNIQUES AND PERIOPERATIVE COMPLICATIONS

We have performed surgical treatment for Moyamoya disease using the su perficial temporal artery to middle cerebral artery (STA-MCA) anastomo sis and encephalo-duro-arterio-myo-synangiosis (EDAMS). In this paper, the surgical technique of combined revascularization for Moyamoya dis ease as well as peri-operative complications are discussed. Craniotomy and dural opening were extensively carried out to expose the brain su rface as widely as possible. Dissection of the STA, which is the most powerful resource of direct revascularization, should be carefully car ried out using a surgical microscope. The temporal muscle and middle m eningeal artery, which have the most potential as sources of indirect revascularization, must be preserved. STA-MCA anastomosis to the front al branch of the middle cerebral artery is indispensable for improving cerebral circulation of the frontal lobe. A small arachnoid membrane opening and water-tight closure are also important to avoid pest-opera tive subdural and subcutaneous fluid collection. Ischemic events disap peared immediately after surgery in most cases. However, in several ca ses, transient ischemic attacks recurred for several months after the surgery. Chronic subdural hematoma was seen in two cases. (C) 1997 Els evier Science B.V.