Direct Vascular Reconstruction to Anterior and Middle Cerebral Artery and Its Effect for Moyamoya Disease

Vascular reconstruction for moyamoya disease can be achieved by STA-MCA anastomosis, STA-ACA anastomosis as direct revascularization, EDAMS (encephalo-duro-arterio-myo-synangiosis) and EGAS (encephalo-galeo-arterio-synangiosis) as indirect vascular reconstruction. We revascularized 19 hemispheres of 13 patients—4 pediatric and 9 adult patients—using STA-ACA and STA-MCA anastomosis, EGAS for the medial frontal lobe, and EDAMS for the lateral frontal lobe. All of these procedures improved cerebral blood flow in the frontal lobe, resulting in improved mental and intellectual acuity in pediatric patients, which was apparent from obviously improved concentration and intellectual ability soon after surgery.