Reconstructive Vascular Surgery in the Territory of the Anterior Cerebral Artery in Children with Moyamoya Disease

Abstract

The hemodynamics of the anterior cerebral arteries (ACAs) were studied in 28 children with moyamoya disease. In 39% of 56 cerebral hemispheres, antegrade filling of the ACAs was not verified by preoperative angiography. On the other hand, adequate collateral pathways to the ACA territory were generally not achieved by encephalomyosynangiosis (EMS) or superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. The authors have devised new surgical methods for the revascularization of the ACA territory, which they term “encephaloarteriosynangiosis” (EAS) and “encephalogaleosynangiosis” (EGS). In these procedures, one or several burr holes are made in the frontal skull, the dura mater is incised, and either the frontal branch of the STA or the pedicled galea aponeurotica stump is placed on the surface of the frontal cortex. In addition to EMS or STA-MCA anastomosis, these methods were applied to 23 cerebral hemispheres in 14 pediatric patients. In 14 cerebral hemispheres (61%) of 10 patients, postoperative external carotid angiograms showed some cortical branches in the ACA territory, and clinical improvement was achieved in patients with transient ischemic attacks affecting the lower extremities. The results of this study demonstrate that EAS and EGS are simple and useful techniques for revascularization of the ACA territory. In addition, EGS can be applied to the territory of the posterior cerebral artery. © 1989, The Japan Neurosurgical Society. All rights reserved.