Simultaneous STA-ACA and STA-MCA Bypass Combined with Extensive Indirect Revascularization for Treatment of Childhood Moyamoya Disease

We report the results of 14 children with moyamoya disease who underwent simultaneous superficial temporal artery to anterior cerebral artery (STA-ACA) and superficial temporal artery to middle cerebral artery (STA-MCA) bypass combined with extensive indirect revascularization.In a total of 21 procedures, the median operative time was 6.15 hours, and no patient experienced surgical wound complication. Technical success of STA-ACA bypass was observed in 19 (90.5%) procedures. In the other two cases, the procedure was changed from simultaneous STA-ACA/STA-MCA bypass to STA-MCA double bypass, because the appropriate recipient artery could not be found. In all of the 14 procedures, single-photon emission computed tomography revealed improved cerebral blood flow and vascular reserve in the ACA territory after the operation.We conclude that simultaneous STA-ACA and STA-MCA bypass combined with extensive indirect revascularization is effective for improvement of hemodynamic insufficiency in the ACA and MCA territories. Moreover, it could prevent surgical wound complication by reducing the need for further surgical procedures in childhood moyamoya disease.