Direct Cerebral Bypass Supplements Indirect Bypass Procedures in Moyamoya Disease

摘要: Moyamoya disease is a unique of unknown etiology characterized by progressive occlusion the supraclinoid portion bilateral internal carotid arteries (IC), and proximal portions anterior (ACA) middle cerebral (MCA). Occlusion posterior circulation also involved in 30–40% patients. In most recommended procedures till date, either direct and/or indirect bypass surgery has been advocated to improve perfusion. present study, we performed combined that included both as well ones [1,2]. The combination ensured perfusion wider ischemic zone salvaging penumbric area. Indirect like encephalo-duro-arterio-synangiosis (EDAS), encephalo-myo-synangiosis (EMS) or galeal flaps are safe easy. Direct surgery, however, more reliable providing adequate blood flow but technically difficult recipient artery running on cortical surface usually fine fragile moyamoya disease.