Abstract
Middle meningeal arteries (MMA) are usually found and hemorrhage on the surface of the dura mater occurs after completion of craniotomy in vascular reconstruction for cerebral ischemia in the territory of the middle cerebral artery in moyamoya disease. The hemostatic procedure is usually performed macroscopically. Macroscopically-performed electrocoagulation may cause stenosis or occlusion of the MMA and its branches, and spontaneously developed collaterals to the brain via the MMA may decrease or stop, abruptly. Cerebral ischemia can be aggravated. In the present report, the importance of the hemostatic procedure under surgical microscopy was investigated in a consecutive series of sixteen patients with moyamoya disease. Hemorrhage usually occurred from the fine branches between the MMA and vessels through the cranium. Those branches were left adjacent to the MMA. Electrocoagulation of the branches under the microscope effectively stopped hemorrhage on the dura mater. The microscopically-performed hemostatic procedure could preserve the MMA and did not disturb collateral pathways via the MMA.
