Combined encephalo-arterio-synangiosis and encephalo-myo-synangiosis in the treatment of Moyamoya disease

From January 1990 to December 1995, a total of nine cases of Moyamoya disease were treated at the National Taiwan University Hospital with combined encephalo-arterio-synangiosis (EAS) and encephalo-myo-synangiosis (EMS). There were five males and four females and their ages ranged from 6 months to 31 years. Of these, two cases had their first symptom as intracranial hemorrhage and the rest of the cases had ischemic manifestations. Surgical treatment with combined EAS and EMS was performed on 16 hemispheres of the nine cases. The superficial temporal artery with its anterior and posterior branches was isolated and fixed to the pial surface. Then, the muscle pedicle from the bivalved temporal muscle was used as a dural graft to cover the artery. All the cases showed good neovascularization on follow-up angiography performed at 2-3 months after surgery. These two patients with hemorrhagic symptoms were followed for 52 and 61 months, respectively. Neither of these two cases showed recurrent bleeding. For patients with ischemic symptoms, the follow-up period ranged from 8 to 73 months (mean 41.7 months). All the patients showed improvement in their clinical symptoms.