Superficial temporal artery-middle cerebral artery anastomosis combining with encephaloduromyosynangiosis:for treatment of moyamoya disease

Objective To evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery[STA-MCA] anastomosis combining with encephaloduromyosynangiosis in treatment of moyamoya disease. Methods Thirty-one procedures of direct STA-MCA bypass combined with encephaloduromyosynangiosis were performed on 22 hemispheres in 21 cases of ischemic-type and 6 cases of hemorrhagic-type moyamoya disease. According to Suzuki's(1969) criterion, 6 cases were in stage 3, 11 cases in stage 4, 7 cases in stage 5, and 3 cases in stage 6. The patency of the anastomosis was verified using intraoperative ultrasonic Doppler and CTA after operation. The change of the brain blood flow was assessed using CTP or TCD within 1 week. DSA was need for followed up study after 4~6 months. Results All the 31 direct anastomoses were patent. The cerebral blood flow in the effected regions increased immediately after operation. The ischemic symptoms were relieved in all the patients. No rebleeding was found on follow up. Spontaneous revascularization from the deep temporal artery and the middle meningeal artery was found in all 7 DSA followed up cases. Only 1 case had a complication of small infarction near the anastomosis. Conclusions We named indirect revascularization using temporal muscle (the deep temporal artery) and the dura mater (the middle meningeal artery) asencephaloduromyosynangiosis (EDMS). The combination of STA-MCA bypass with EDMS is a new rational cerebral revascularization in treatment of moyamoya disease.