During the period from March 1990, through September 1993, 11 patients with moyamoya disease underwent superficial temporal artery (STA)-to-middle cerebral artery (MCA) anastomosis and encephalomyosynangiosis (EMS) bilaterally. The mean follow-up
period
was 30.6months (range 17 to 42 months). The most frequent computed tomographic findings were intraventricular hemorrhage in adult patients and cortical infarction in pediatric patients. In all of the patients, confirmatory diagnosis could be made
by
angiography, and all had typical angiographic findings of moyamoya disease. According to angiographic classification by Suzuki, the most frequent phase was stage three. A modified continuous suture technique was used during anastomosis. The
advantages
of this microvascular suture technique are saving time for the surgical procedure, lessening bleeding from the anastomotic site and the ease and safety with which anastomosis can be achieved in the deep cranial cavity. Postoperatively, follow-up
angiography was taken between 1 year and 2 years after operation. The angiographic revascularization rate was 100%, excellent in 6, and good in 5. The typical postoperative angiographic findings are as follows : 1) reduction of moyamoya vessels,
2)
normalization or improvement of abnormal posterior circulation, 3) visualization of MCA territory through MCA-STA bypass, and 4) dilatation of STA. There were no major complications in patients with surgery, and no poor outcomes. These results
indicate
that the STA-MCA anastomosis and EMS in moyamoya disease can normalize cerebral circulation and reduce repeated ischemic attack and repeated bleeding.
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