COMBINED REVASCULARIZATION SURGERY FOR CHILDHOOD MOYAMOYA DISEASE - STA-MCA AND ENCEPHALO-DURO-ARTERIO-MYO-SYNANGIOSIS

We present surgical techniques for optimal revascularization in childh ood moyamoya disease. During the past 10 years we performed revascular ization surgery for childhood moyamoya disease using direct revascular ization with superficial temporal artery to middle cerebral artery (ST A-MCA) anastomosis and indirect revascularization of encephalo-duro-ar terio-myo-synangiosis (EDAMS) 43 times. Points of this surgery are as follows: (1) craniotomy and dural opening for the most extensive possi ble exposure of the brain surface, (2) protective manipulation of the STA, temporal muscle and middle meningeal artery, (3) STA-MCA anastomo sis to the frontal branch of the MCA to improve cerebral circulation o f the frontal lobe using a small branch of the STA, and (4) a small op ening in the arachnoid membrane and watertight closure.