Omental transplantation using a superficial temporal artery previously used for encephaloduroarteriosynangiosis

Abstract

Childhood moyamoya disease is a chronically progressive cerebrovascular occlusive disease affecting the territories of the anterior, middle, and posterior cerebral arteries. Surgery used in treatment of moyamoya disease to vascularize the brain include direct and indirect anastomoses. Intracranial omental transplantation (OMT) was performed using a branch of the superficial temporal artery (STA) that had been used previously for encephaloduroarteriosynangiosis (EDAS) in five children with moyamoya disease. All five children continued to have paraparetic transient ischemic attacks (TIAs), urinary incontinence, and/or progressive mental retardation even after EDAS and/or STA-middle cerebral artery (MCA) anastomosis and encephalomyosynangiosis (EMS) to the territory of the MCA. Previously performed EDAS gave insufficient collaterals to the territory of the MCA in four of the five patients and sufficient collaterals to the territory of the MCA in the remaining patient. OMT was performed after stripping of a branch of the STA used in EDAS that gave insufficient collaterals to the brain in the former four patients; and the latter patient was performed using a parietal branch of the STA distal to the distal burr hole drilled in the previous EDAS. OMT resulted in marked improvement in neurologic conditions in all five patients. Four of the five patients suffered no TIAs postoperatively, while the remaining patient still had TIAs but at a markedly decreased frequency. In summary, OMT using a branch of the STA used in previously performed EDAS is required for patients with moyamoya disease who continue to manifest paraparesis, urinary incontinence, and/or progressive mental retardation even after multiple EDAS.