Moyamoya disease is a chronic occlusive cerebrovascular disease of unknown etiology for which no effective treatment has been found. The authors report the result of 23 superficial temporal-middle cerebral artery (STA-MCA) anastomoses and seven encephalomyosynangioses, performed on 13 cases with moyamoya disease and on four additional atypical cases. There were 10 children and seven adults in this study. The follow-up period ranged from 1 year and 4 months to 4 years and 1 month postoperatively; nine patients had excellent results, five good, and one fair; two patients were unchanged. The anastomotic procedure was most effective for transient ischemic attacks, reversible ischemic neurological deficits, and even minor or moderate neurological symptoms. The STA-MCA anastomosis appears to be an effective treatment for moyamoya disease.
SummaryAn operation to place the temporal muscles on the brain surface, namely Encephalo Myo Synangiosis, was carried out on 10 patients with "Moyamoya" disease lacking the middle cerebral artery on the brain surface for anastomosis.Postoperative superselective deep temporal angiogram proved the development of rich vascular supply from the temporal muscle to the brain surface. Satisfactory clinical improvements were seen in nine patients. The remaining one child with transient ischemic attacks (TIA) and major neurological deficits showed slight improvement in spite of being unable to take care of himself. The other nine patients also showed improved electro encephalographic findings. Significant blood supply through the external carotid system to the operated area of the brain was shown in some cases by appearance of diffuse slow activity when the common carotid artery on the same side was compressed.
✓The authors report and discuss two cases in which collateral circulation could be angiographically demonstrated passing through the anterior spinal artery. Case 1 proved to have occlusions of the left internal carotid artery and both vertebral arteries. The basilar artery was visualized via the anterior spinal, the primitive trigeminal, and primitive otic arteries. The presence of multiple vascular malformations and an abnormal anterior spinal artery suggested that the latter had been functioning as collateral circulation since an embryonic stage. In Case 2, both internal carotids and both vertebral arteries were occluded by arteriosclerotic changes. It was assumed that the deleted anterior spinal artery visualized angiographically had developed into a collateral circulation with increasing age.
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