As a mean of treating pediatric moyamoya patients, we have developed an operative procedure termed“encephalo-duro-arterio-synangiosis (EDAS) which consists of making a narrow craniotomy through which to transplant and suture a partial, free stem of the scalp artery attached with a strip of galea onto linear cut wound made in the dura mater, for the purpose of assisting anastomosis formation between the extracranial and intracranial arteries, which we apply on pediatric moyamoya patients and have achieved improvement of blood flow in the brain and general conditions.
We used the EDAS procedure on 9 pediatric cases and gained good results, and part of the results were reported at the 39th congress of the Japan Neurosurgical Society.
We had a chance of application of EDAS to an adult patients, which we are reporting hereunder.
The case was a 20-year-old female, who developed this disease with onset of subarachnoid hemorrhage. Three months after the onset of the disease we conducted EDAS using the left superficial temporal artery and now the patient is in the firth month after the operation.
According to our observations in children up to this time, the progress of revascularization of the brain by EDAS seems to follow the following steps (1) Thickening and increase of dural arteries. (2) Thickening of donor scalp artery. (3) Visible spontaneous anastomoses formation between the donor scalp artery and cerebral blood vessels. (4) In accordance with the thickening of the donor scalp artery, the abnormal vascular network at the bettom of the brain (moyamoya vessels) shrink away.
In this case, at 1.5 months after the EDAS, the above condition (1) was observed when the cerebral angiography was done, and at 4 months, the above (3) was seen partially formed. In view of these facts, we conclude that EDAS can be at least an alternative procedure of EC-IC bypass method in adult cases as well as in pediatric cases of moyamoya disease.
