Neovascularization (angiogenesis) after revascularization in Moyamoya disease. Which technique is most useful for Moyamoya disease?

The effects of direct and indirect revascularization for moyamoya disease w ere analyzed for each donor artery to determine which surgical procedure is most useful for the induction of neovascularization. In the past 12 years, 85 patients with moyamoya disease were surgically tre ated by combined surgery consisting of indirect revascularization via encep halo-duro-arterio-myo-synangiosis (EDAMS) and direct revascularization via the superficial temporal artery and the middle cerebral artery (STA-MCA) by pass. Among those patients, the post-operative changes in digital subtracti on angiography were examined in 56 sides, including 34 sides in paediatric cases and 22 sides in adult cases. The neovascularization after indirect re vascularization using the 1) superficial temporal artery (skin), 2) middle meningeal artery (dura mater), 3) deep temporal artery (temporal muscle) wa s analyzed. As results, in paediatric cases, the deep temporal artery and middle mening eal artery induced good neovascularization. However, the induction of neova scularization from the superficial temporal artery was not always good in m ost pediatric and adult cases. On the other hand, the direct bypass was use ful in 90% of adult cases. In indirect revascularization surgery for moyamoya disease, the temporal mu scle (the deep temporal artery) and the dura mater (the middle meningeal ar tery) are useful donors to the ischemic brain. The simple encephalo-arterio -synangiosis is not always effective. The direct bypass is a useful techniq ue for adult moyamoya disease.