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, Tatsuya; Kamiyama, Hiroyasu; Kuroda, Satoshi; Yasuda, Hiroshi; Nakayama, Naoki; Takizawa, Kazuyasu

doi:10.2176/nmc.46.462

Cited by 49 publications

(31 citation statements)

References 23 publications

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“…(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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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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“…The use of frontal pericranial flaps to induce neoangiogenesis in patients with MMV has shown to be an effective technique. [6,11,15,[23][24][25][26] The choice of using the periosteum (frontal pericranium) for the bifrontal revascularization relies on the abundant blood supply, providing nourishment to the bone, and potentially promoting neoangiogenesis. [11] The frontal pericranium receives blood supply mainly from the supraorbital and supratrochlear arteries (as well as from frontal branches of the STA), emphasizing the importance of preparing the pericranial flap pediculated anteriorly over the orbits to preserve its vascular supply.…”

Section: Advantages and Disadvantages Of The Proposed Techniquementioning

confidence: 99%

“…[1][2][3] Combined revascularization procedures provide the advantages of both techniques. [2][3][4][5][6][7] In addition to symptoms that can be ascribed to the MCA territory, children may present with lower extremity motor weakness and neuropsychological dysfunctions probably due to involvement of the frontal lobes. [8][9][10][11][12] In pediatric MMV, the cerebral blood flow (CBF) in the bifrontal areas as well as in the anterior watershed territory may continue to worsen despite good collateral formation or successful revascularization of the MCA territory.…”

Section: Introductionmentioning

confidence: 99%

“STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis” as a one-staged revascularization strategy for pediatric moyamoya vasculopathy

et al. 2015

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PURPOSE Moyamoya vasculopathy progressively compromises cerebral blood flow resulting in chronic hypoperfusion. The middle cerebral artery (MCA) territory and the bifrontal areas are the regions most frequently affected. Although most techniques aim to only revascularize the MCA territory, augmentation of blood flow of the bifrontal areas is of importance in the pediatric moyamoya population since these regions play an important role in cognition, intellectual development, and in lower extremity and sphincter function. We recently described a one-staged surgical procedure combining revascularization of three regions, the MCA territory unilaterally and the frontal areas bilaterally. The purpose of this article is to report our surgical experience in eight children and to emphasize the rational for bifrontal revascularization. METHODS We report a case series consisting of eight children where the following surgical strategy was applied: (1) a direct superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass with encephalo-duro-myo-synangiosis (EDMS) for unilateral MCA revascularization; in combination with (2) a bifrontal encephalo-duro-periosteal-synangiosis (EDPS) for bifrontal revascularization. Patients' characteristics and 30-day follow-up data are reported. RESULTS The patient group consisted of six girls and two boys (mean age 10.0, range 4.2-17.5 years): six children presented with moyamoya disease, two with moyamoya syndrome. We performed a one-staged revascularization of one MCA territory and both frontal areas in all patients. No significant complications occurred. Two patients experienced postoperative focal seizures, successfully treated with anti-epileptic medication. CONCLUSIONS The single-staged STA-MCA bypass with EDMS combined with bifrontal EDPS allowed revascularization of three regions (the MCA territory unilaterally and the frontal areas bilaterally) and may serve as an alternative and safe treatment option for pediatric moyamoya patients. Originally published at: Esposito, Giuseppe; Kronenburg, Annick; Fierstra, Jorn; Braun, Kees P J; Klijn, Catharina J M; van der Zwan, Albert; Regli, Luca (2015). "STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis" as a one-staged revascularization strategy for pediatric moyamoya vasculopathy. Child's Nervous System, 31 (5) hypoperfusion. The middle cerebral artery (MCA) territory and the bifrontal areas are the regions most frequently affected. Although most techniques aim to only revascularize the MCA territory, augmentation of blood flow of the bifrontal areas is of importance in the pediatric moyamoya population since these regions play an important role in cognition, intellectual development, and in lower extremity and sphincter function. We recently described a one-staged surgical procedure combining revascularization of three regions, the MCA territory unilaterally and the frontal areas bilaterally. The purpose of this article is to report our surgical experience in e...

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“…26,39,47) However, direct STA-ACA anastomosis is not always essential in all patients with moyamoya disease, 10,11) probably because the surgical collaterals to the MCA territory may also provide blood flow to the ACA territory through the pial anastomosis. Thus, the collateral blood flow may be redistributed after surgery.…”

Section: Direct Bypass Proceduresmentioning

confidence: 99%

“…The frontal branch of STA should be dissected from the scalp to as great a length as possible, which enables easier handling during STA-ACA anastomosis. 10,17) The frontal branch of STA can be anastomosed to the cortical branch of ACA close to the midline with the usual technique, but the direct bypass procedure should be performed more carefully, because the calibers of both donor and recipient vessels are often smaller than the usual situation in STA-MCA anastomosis (Fig. 2).…”

Section: Direct Bypass Proceduresmentioning

confidence: 99%

Bypass Surgery for Moyamoya Disease

Kuroda

Houkin

2012

Neurol. Med. Chir.(Tokyo)

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This review describes the basic concepts of surgical revascularization for moyamoya disease, including direct and indirect bypass surgery. Direct bypass surgery can improve cerebral hemodynamics and reduce further ischemic events immediately after surgery, but may be technically challenging in some pediatric patients. Indirect bypass surgery is simple and has widely been used. However, its beneficial effects can be achieved 3 to 4 months after surgery, and surgical design is quite important to determine the extent of surgical collateral pathways. Combined bypass procedure, especially superficial temporal artery (STA) to middle cerebral artery anastomosis and indirect bypass, encephalo-duro-myo-arteriopericranial synangiosis, is a safe and effective option to improve the short-and long-term outcome in patients with moyamoya disease. Alternative techniques are also described for specific cases with profound cerebral ischemia in the anterior cerebral artery or posterior cerebral artery territory. Special techniques to safely complete bypass surgery and avoid perioperative complications are presented, including methods to prevent delayed wound healing, to avoid facial nerve palsy after surgery, and to preserve the STA and middle meningeal artery during skin incision and craniotomy. Finally, the importance of careful management of patients is emphasized to reduce the incidence of perioperative complications, including ischemic stroke and hyperperfusion syndrome.

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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-

Cited by 49 publications

References 23 publications

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

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

“STA-MCA bypass with encephalo-duro-myo-synangiosis combined with bifrontal encephalo-duro-periosteal-synangiosis” as a one-staged revascularization strategy for pediatric moyamoya vasculopathy

Bypass Surgery for Moyamoya Disease

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