Surgical Revascularization

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Surgery for Moyamoya disease and syndrome is currently the only treatment option for this problem. There are different surgical options including superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery, encephaluduroarteriosynangiosis (EDAS), encephaloduromyosynangiosis (EDAM) and multiple burr hole surgery. EDAM and mulitple burr hole surgery tend to be reserved for situations when there is no obvious donor artery available, or for patients that continue to have symptoms after revascularization surgery. 

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STA-MCA bypass involves dissecting the artery of the scalp, making a craniotomy (using a special medical drill to remove a window of bone), and surgically connecting this artery to the artery of the brain. 

Benefits

- Immediate resoration of blood supply

- Good long term results

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Drawbacks

- Depends on a large enough scalp artery

- Requires temporary occlusion of the artery in the brain to sew in the scalp artery

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EDAS procedure involves dissecting the artery of the scalp making a craniotomy (using a special medical drill to remove a window of bone), and laying the scalp artery onto the surface of the brain and letting the artery grow new connection to supply blood to the brain over time. 

Benefits

- Does not require temporary occlusion of the brain artery

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Drawbacks

- Takes time for new arteries to grow

- Sometimes if brain needs a high level of blood flow restored this may not bring enough blood flow. 

STA-MCA bypass involves dissecting the artery of the scalp, making a craniotomy (using a special medical drill to remove a window of bone), and surgically connecting this artery to the artery of the brain.