A Novel Technique Of Encephalo-STA-STF-synangiosis(EAFS) For Moyamoya Disease

Moyamoya disease is a chronic progressive cerebrovascular disease of unknown origin, which is characterized by stenosis or occlusion of the terminal portion of the internal carotid artery or proximal portion of the anterior and/or middle cerebral arteries accompanied by an abnormal vascular network. Currently, there is no definitive medical treatment to reverse or stabilize the course of moyamoya disease. There are two classes of medications that play an adjuvant role in the treatment of moyamoya: antiplatelet agents and calcium channel blockers. Through the provision of collateral pathways, surgical revascularization is the most successful therapy to improve cerebral hemodynamic and to reduce the risk of subsequent stroke. Surgical procedures for moyamoya disease can be classified into two categories: direct and indirect revascularization procedures. The effect of direct procedures is often effective in adult and pediatric patients, but the small caliber of donor and recipient artery in some cases make it technically very challenging to accomplish a successful anastomosis. Patients with direct procedures are also risk of postoperative anastomotic stenosis or occlusion. A wide variety of indirect revascularization procedures have the ability to provide stable blood supply to the moyamoya-affected brain once formed adequate cerebral collateralization. The temporal muscle utilized as vascularized tissues for indirect revascularization procedures. However, this may affect the appearance caused by temporal hollowing and induce neurological deficit or epilepsy caused by the mechanical swollening, proliferation, compression and bioelectricity of the temporal muscle. Encephalo- duro- arterio- synangiosis(EDAS) using the branch of superficial temporal artery(STA) is an effective and safe method for moyamoya patients. However, the trajectory of the vertebral is unchangeable and the area and extent of the contact between STA and the brain surface is small. Therefore, a novel indirect revascularization procedure, encephalo- superficial temporal artery- superficial temporal fascia flap-synangiosis(EAFS), is designed and has been used for moyamoya disease by the Cerebrovascular Diseases Center of Neurosurgery Department, Tangdu Hospital since 2005.Objective: The purpose of this study is to evaluate the efficacy and safety of a novel indirect cerebral revascularization method of Encephalo- STA- STF-synangiosis(EAFS)for moyamoya disease.Method: A retrospective study was carried out focusing on patients with moyamoya disease underwent by EAFS in the vascular database of Neurosurgery Department, Tangdu Hospital from 2005 to 2014. All information including patients’ symptom and sign, angiographic examination, procedure and complications, clinical and angiographic results was collected and analyzed.Results: All 31 patients receiving 36 EAFS were selected. They were followed up with a mean period of 20 months, ranging from 6 to 59 months, and 83.9% of them had excellent or good clinical result. 22 cases followed up with DSA with a mean period of 17 months, ranging from 6 to 45 months,and 54.5%of them had good-revascularization. There were 6 complications relating to procedure, but none had permanent neurological deficit and only one case with hair growth-retardation.Conclusions: Our results showed the EAFS, a novel indirect revascularization for moyamoya disease, was a safe and effective method, especially for the younger patients. But it needs more cases to prove.