Background and Purpose-The efficacy of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in adult moyamoya disease was evaluated by clinicopathophysiological studies. Methods-Fifteen patients with cerebral ischemic attacks (ischemia group) and 15 patients with intracranial hemorrhages (hemorrhage group) were investigated. Clinicoangiographic features and regional cerebral blood flow (rCBF) of the MCA territory were preoperatively and postoperatively investigated, and cortical arterial pressure (CAP) and anastomotic blood flow (AF) were intraoperatively measured.

A case of subarachnoid hemorrhage from ruptured aneurysm of the basilar bifurcation associated with occlusions of both internal carotid arteries at the neck is presented. Each internal carotid artery mainly received collateral flow at the cavernous portion from the internal maxillary artery through anastomotic artery of the foramen rotundum. Posterior circulation also supplied collateral blood flow via the right posterior communicating artery. This case report suggests that hemodynamic stress may be regarded as an important factor in the formation or development of cerebral aneurysm.

This study suggests that the MFV at the M1 segment is inadequate for estimation of the severity of VSP extending to vessels more peripheral than the M1 segment. Furthermore, severe VSP extending to more peripheral sites can produce more serious ischemic insults, compared with that localized to basal vessels. Patients with negative TCD results and clinical features suggesting the development of VSP should undergo quantitative investigation of cerebral circulatory parameters, such as the CCT, using intra-arterial digital subtraction angiography.

The ostium of the recipient artery and the orifice of the donor artery must be clearly visualized for the establishment of microvascular anastomosis. Specially designed colored flexible cylindrical or Tshaped silicone rubber stents were made in various sizes (400 or 500 um diameter and 5 mm length) and applied to bypass surgery in patients with occlusive cerebrovascular disease such as moyamoya disease and internal carotid artery occlusion. The colored flexible stents facilitated confirmation of the ostium of the artery even in patients with moyamoya disease and allowed precise microvascular anastomosis without problems caused by the stent.

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