The area of revascularization using the temporal muscle and/or the superficial temporal artery is restricted to the lateral aspect of the cerebral hemisphere because these donor tissues distribute inferior to the superior temporal line. To improve the surgical result, the residual ischemic area in the superior aspect of the hemisphere should be revascularised. Dural arteries are appropriate donors for this purpose. At surgery, the dura near the middle meningeal artery was split into outer and inner layers, and the split surfaces of the outer layers were attached to the cortex.
This procedure, combined with encephalo-duro-arterio synangiosis, was applied to 25 hemispheres in 18 patients with pediatric moyamoya disease (mean age, 6 years). Postoperative selective angiograms of the middle meningeal artery demonstrated effective cortical revascularization covering the superior aspect of the hemisphere. All the patients were symptom free by 1.5 years after surgery.
Revascularization of the superior aspect of hemisphere is an important consideration for the improvement of surgical results.
