The mainstay surgical treatment for patients with moyamoya disease is vascular reconstruction to increase blood flow in the middle cerebral artery territory. We have added the superficial temporal artery as the direct and the pericranium as the indirect vascular reconstruction technique to irrigate the anterior cerebral artery territory. Although as a result cerebral blood flow improved in a wide tissue area, the incidence of wound complications due to the sacrifice of blood flow to the external carotid artery territory tended to increase. It is necessary to continue searching for a procedure that will result in good cerebral blood flow with a reduced incidence of complications.
