Surgical Planning for Direct Anastomosis on a Childhood Moyamoya Disease Patient with No Visualization of a Proximal Portion of the STA: A Case Report

Abstract

Surgical revascularization including direct/indirect anastomosis is needed in childhood moyamoya disease. In the present study, I report a moyamoya disease patient on which direct anastomosis could be performed in spite of no visualization of a proximal portion of a superficial temporal artery (STA). An 11-year-old boy was admitted to our clinic on June 27, 2012, for repetitive headache and transient ischemic attacks (TIAs) associated with dysarthria, sensory disturbance and monoparesis of his right arm, and monoparesis of his left leg. He had had repetitive TIAs associated with right hemiparesis and a surgical procedure on the right brain at another hospital because the proximal portion of left STA was not visualized on preoperatively performed cerebral angiography. The scalp artery was separated from the distal portion of the left STA to a branch of the ipsilateral occipital artery, and the end of the distal STA could be directly anastomosed to a branch of the middle cerebral artery. Direct anastomosis may be successfully performed by precise inspection of obtained cerebral angiograms and careful preparement of the donor artery even in a situation without visualization of a proximal portion of the STA.