Combined direct and indirect superficial temporal artery-to-middle cerebral artery bypass with a hinged bone flap: how I do it

Robert C Rennert; Karol P Budohoski; Ramesh Grandhi; William T Couldwell

doi:10.1007/s00701-022-05393-6

Combined direct and indirect superficial temporal artery-to-middle cerebral artery bypass with a hinged bone flap: how I do it

Acta Neurochir (Wien). 2022 Dec;164(12):3203-3208. doi: 10.1007/s00701-022-05393-6. Epub 2022 Oct 24.

Authors

Robert C Rennert¹, Karol P Budohoski¹, Ramesh Grandhi¹, William T Couldwell²

Affiliations

¹ Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
² Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA. [email protected].

PMID: 36279012
DOI: 10.1007/s00701-022-05393-6

Abstract

Background: Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass is a critical treatment for moyamoya disease and steno-occlusive cerebrovascular disease. Combined bypass (direct + indirect) optimizes the chance of durable flow augmentation but can complicate wound closure from tissue disruption.

Methods: We describe our technique for combined direct and indirect (encephaloduromyosynangiosis; EDAMS) STA-MCA bypass using a hinged bone flap. In addition to a direct bypass, EDAMS provides multiple sources for indirect revascularization. The hinged bone flap gently approximates the muscle and pia for secondary vascular ingrowth.

Conclusions: Combined STA-MCA bypass with a hinged bone flap safely maximizes revascularization potential.

Keywords: Bypass; Moyamoya; Steno-occlusive cerebrovascular disease; Superficial temporal artery.

MeSH terms

Cerebral Revascularization* / methods
Cerebrovascular Disorders*
Humans
Middle Cerebral Artery / surgery
Moyamoya Disease* / complications
Moyamoya Disease* / diagnostic imaging
Moyamoya Disease* / surgery
Temporal Arteries / surgery