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

  • Annick Kronenburg
  • Giuseppe Esposito
  • Jorn Fierstra
  • Kees P. Braun
  • Luca Regli
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 119)

Abstract

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.

Keywords

Bilateral frontal territories Bypass surgery STA-MCA bypass Indirect revascularization Moyamoya Neurocognition 

Abbreviations

ACA

Anterior cerebral artery

CBF

Cerebral blood flow

CVR

Cerebrovascular reserve

EDS

Encephalo-duro-synangiosis

EDMS

Encephalo-duro-myo-synangiosis

EMS

Encephalo-myo-synangiosis

EDPS

Encephalo-duro-periosteal-synangiosis

EPS

Encephalo-periosteal-synangiosis

[15O]H2O-PET

[15O]H2O-positron emission tomography

ICA

Internal carotid artery

IF

Interhemispheric fissure

MCA

Middle cerebral artery

MMD

Moyamoya disease

MMS

Moyamoya syndrome

MMV

Moyamoya vasculopathy

SSS

Superior sagittal sinus

STA

Superficial temporal artery

TIA

Transient ischemic attack

Notes

Conflict of Interest

We declare that we have no conflict of interest.

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Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Annick Kronenburg
    • 1
  • Giuseppe Esposito
    • 2
  • Jorn Fierstra
    • 2
  • Kees P. Braun
    • 1
  • Luca Regli
    • 2
  1. 1.Department of Neurology and NeurosurgeryBrain Center Rudolf Magnus, UMC UtrechtUtrechtThe Netherlands
  2. 2.Department of NeurosurgeryUniversity Hospital ZürichZürichSwitzerland

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