Ribbon enchephalo-duro-arterio-myo-synangiosis for moyamoya disease

Kinugasa, Kazushi; Mandai, Shinya; Tokunaga, Koji; Kamata, Ichiro; Sugiu, Kenji; Handa, Akihiro; Ohmoto, Takashi

doi:10.1016/0090-3019(94)90007-8

Cited by 79 publications

(31 citation statements)

References 8 publications

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“…Patients with advancing disease can eventually suffer from frontal or occipital ischemia that is not targeted by the direct bypass procedure alone. 25,28 These disadvantages must be balanced against those of the remaining options.…”

Section: Neurosurg Focus / Volume 24 / February 2008mentioning

confidence: 99%

Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

Veeravagu¹,

Guzman²,

Patil³

et al. 2008

FOC

117

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✓Neurosurgical interventions for moyamoya disease (MMD) in pediatric patients include direct, indirect, and combined revascularization procedures. Each technique has shown efficacy in the treatment of pediatric MMD; however, no single study has demonstrated the superiority of one technique over another. In this review, the authors explore the various studies focused on the use of these techniques for MMD in the pediatric population. They summarize the results of each study to clearly depict the clinical outcomes achieved at each institution that had utilized direct, indirect, or combined techniques. In certain studies, multiple techniques were used, and the clinical or radiological outcomes were compared accordingly. Direct techniques have been shown to aid a reduction in perioperative strokes and provide immediate revascularization to ischemic areas; however, these procedures are technically challenging, and not all pediatric patients are appropriate candidates. Indirect techniques have also shown efficacy in the pediatric population but may require a longer period for revascularization to occur and perfusion deficits to be reversed. The authors concluded that the clinical efficacy of one technique over another is still unclear, as most studies have had small populations and the same outcome measures have not been applied. Authors who compared direct and indirect techniques noted approximately equal clinical outcomes with differences in radiological findings. Additional, larger studies are needed to determine the advantages and disadvantages of the different techniques for the pediatric age group.

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Section: Neurosurg Focus / Volume 24 / February 2008mentioning

confidence: 99%

Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

Veeravagu¹,

Guzman²,

Patil³

et al. 2008

FOC

117

View full text Add to dashboard Cite

show abstract

“…It represents a good alternative to the existing techniques for frontal territories revascularization such as the technically challenging direct STA-ACA bypass or other procedures that need exposure of the interhemispheric fissure (IF). [10][11][12][13]. In fact, the use of separate frontal parasagittal craniotomies, located one on the left-and one the right-side 2 cm away from the midline, reduces the risk of injuries to the SSS and the parasagittal veins.…”

Section: Discussionmentioning

confidence: 99%

“…(8,11,13,16,18,20,23) The novelty of this technique is unfolded in the one-staged approach combining direct and indirect revascularization in three different areas, with minimal surgical risks (by avoiding the IF and SSS). To our knowledge, this one-staged procedure has not been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Combined Bypass Technique for Contemporary Revascularization of Unilateral MCA and Bilateral Frontal Territories in Moyamoya Vasculopathy

Kronenburg

Esposito

Fierstra

et al. 2014

Acta Neurochirurgica Supplement

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Moyamoya vasculopathy (MMV) leads to chronic hypoperfusion predominantly in the middle cerebral artery (MCA) and anterior cerebral artery (ACA) territories. Most revascularization techniques focus on revascularization of the MCA territory. Augmentation of blood flow in the frontal area is important for neurocognition and lower extremity function. In this article we describe a new combined (direct and indirect) one-stage bypass technique consisting of a superficial temporal artery to middle cerebral artery (STA-MCA) bypass with encephalo-duro-synangiosis (EDS) for unilateral MCA revascularization, along with an encephalo-duro-periosteal-synangiosis (EDPS) for bifrontal blood flow augmentation. The strength of this technique is the revascularization of three vascular territories during a single surgical intervention: the MCA unilaterally; and the frontal territories bilaterally. Bifrontal EDPS may also be considered as a supplementary independent procedure for patients who previously underwent revascularization treatment in the MCA territory, but develop symptoms due to frontal hypoperfusion. bypass with an encephalo-duro-myo-synangiosis (EDMS) for unilateral MCA revascularization, along with a encephalo-duro-periosteal-synangiosis (EDPS) for bifrontal blood flow augmentation. The strength of this technique is the revascularization of 3 vascular territories during a single surgical intervention: the MCA unilaterally and the frontal territories bilaterally. Bifrontal EDPS can also be considered as a supplementary independent procedure for patients who previously underwent revascularization treatment in the MCA territory, but develop symptoms due to frontal hypoperfusion.

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“…Direct STA-ACA bypass surgery was performed as a secondary surgery for refractory ischemic episodes. 5,7) Indirect bypass surgery targeting the frontal lobe, 21) ribbon EDAMS, 13) burr holes, 1,11) and dural pedicle insertion over the brain surface combined with encephalo-galeo-synangiosis 23) have also been reported. The present study describes the technical procedure to establish vasoreconstructive surgery including direct bypass for the ACA territory at the first intervention.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Superficial Temporal Artery to Middle Cerebral or Anterior Cerebral Artery Bypass With Pan-synangiosis for Moyamoya Disease Covering Both Anterior and Middle Cerebral Artery Territories-Technical Note-

Ishikawa

Kamiyama

Kuroda

et al. 2006

Neurol. Med. Chir.(Tokyo)

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Some patients with moyamoya disease treated by conventional surgical procedures may develop postoperative refractory ischemia and perioperative cerebral infarction in the anterior cerebral artery (ACA) territory. We present a novel operative procedure for moyamoya disease to avoid the risk of ischemia in the ACA territory, which consists of simultaneous superficial temporal artery (STA) to middle cerebral artery (MCA) or ACA bypass with pan-synangiosis, encephalo-duro-arterio-myosynangiosis for the lateral frontal and temporal areas, and encephalo-galeo-arterio-synangiosis for the medial frontal area. This procedure can establish direct bypass to the ACA territory at the first intervention. Simultaneous STA-MCA and STA-ACA bypasses with pan-synangiosis is suitable for patients with moyamoya disease associated with severely impaired perfusion of the ACA territory requiring direct bypass surgery.

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Ribbon enchephalo-duro-arterio-myo-synangiosis for moyamoya disease

Cited by 79 publications

References 8 publications

Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

Moyamoya disease in pediatric patients: outcomes of neurosurgical interventions

Combined Bypass Technique for Contemporary Revascularization of Unilateral MCA and Bilateral Frontal Territories in Moyamoya Vasculopathy

Simultaneous Superficial Temporal Artery to Middle Cerebral or Anterior Cerebral Artery Bypass With Pan-synangiosis for Moyamoya Disease Covering Both Anterior and Middle Cerebral Artery Territories-Technical Note-

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