Subcutaneous tissue graft including a scalp artery and a relevant vein for the treatment of cerebral ischemia in childhood moyamoya disease

BackgroundSimple indirect anastomosis was introduced for the treatment of moyamoya disease with cerebral ischemia in the territory of anterior cerebral arteries (ACAs) or middle cerebral arteries (MCAs), and its clinical usefulness was discussed.MethodsThe study included 19 patients with childhood moyamoya disease who were operated on with subcutaneous tissue graft including a scalp artery and a relevant vein (group 1). They all had repetitive transient ischemic attacks (TIAs) in the territory of ACAs or MCAs. To compare age, sex, and the time required for the operation, 34 patients with childhood moyamoya disease with direct anastomosis were also included in the (group 2).ResultsNo TIAs were observed in 19 of 21 operative sides during the follow-up period in group 1. The remaining 2 sides continued to have TIAs postsurgically, but with a marked decrease in frequency. There were no significant differences in age and sex between group 1 and group 2. Required time for surgical procedure in group 1 ranged from 103 to 270 minutes (mean ± SD, 167.4 ± 38.8 minutes), and in group 2 from 140 to 320 minutes (215.0 ± 36.2 minutes). The former was significantly shorter than the latter (unpaired t test, t = 4.8773, P = .000007).ConclusionsSubcutaneous tissue graft including a scalp artery and a relevant vein is recommended for the treatment of moyamoya disease presenting ischemia in the territory of the ACAs or MCAs.