画像所見に基づいたもやもや病に対する複合血行再建術(<特集>もやもや病に対する外科治)  [in Japanese] Combined Revascularization Surgery for Moyamoya Disease Based on the Radiological Findings(<Topics>Surgical Treatment for Moyamoya Disease)  [in Japanese]

Indirect revascularization for moyamoya disease can induce good neovascularization in most cases. However, its effect is not always reliable. In this study, we describe combined revascularization of direct bypass of the superficial temporal artery-middle cerebral artery anastomosis and indirect revascularization of encephalo-duro-arterio-myo-synangiosis (EDAMS) based on the preoperative radiological finding. The running course of the 3 donor arteries of the superficial temporal artery (STA), deep temporal artery (DTA) and middle meningeal artery (MMA) is superimposed on the lateral view of the patient's face using digital image technology. In surgery, using these digitally superimposed images, these 3 donor arteries were safely dissected without any injury and well vascularized soft tissue such as the galea aponeuritica, temporal muscle, and the dura mater were placed on the surface of the brain. There are many variations of techniques for the indirect revascularization for moyamoya disease. However, the well-vascularized tissues with preserved donor arteries are indispensable for the best indirect revascularization.