SURGICAL-TREATMENT FOR PEDIATRIC MOYAMOYA DISEASE - USE OF THE SUPERFICIAL TEMPORAL ARTERY FOR BOTH AREAS SUPPLIED BY THE ANTERIOR AND MIDDLE CEREBRAL-ARTERIES

OBJECTIVE: To revascularize ischemic territories of both the anterior cerebral artery (ACA) and the middle cerebral artery (MCA), a simple a nd effective combined bypass operation was performed in 36 pediatric p atients with moyamoya disease during the past 8 years. METHODS: The br anches of the superficial temporal artery (STA) were used to revascula rize the ACA and MCA territories. In children older than 5 years, the parietal branch of the STA was usually used for an end to side anastom osis with a cortical branch of the MCA. In children who were younger t han 5 years, the parietal branch of the STA was used for an encephalod uroarteriosynangiosis instead of a direct anastomosis. Encephaloduroar teriosynangiosis, using the proximal part of the intact frontal branch of the STA, and encephalomyosynangiosis, using the temporal muscle, w ere also performed in all patients to stimulate spontaneous anastomosi s. In addition, bilateral frontal burr holes were made in all patients to induce vascularization of the ACA territories from the distal part of the intact frontal branch of the STA. The first operation was perf ormed on the dominant side, then a similar procedure was performed on the opposite side after an interval of at least 3 months. RESULTS: Pos toperative clinical symptoms and the findings from magnetic resonance imaging, magnetic resonance angiography, angiography, and electroencep halography demonstrated improvement in all patients. CONCLUSION: These results suggest that the placement of bilateral burr holes (while lea ving the frontal branch of the STA intact), in addition to the STA-MCA anastomosis, encephaloduroarteriosynangiosis, and encephalomyosynangi osis, is very effective in vascularizing the ischemic ACA and MCA terr itories in pediatric patients with moyamoya disease.