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Updated: Aug 1, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Combined direct and indirect superficial temporal artery-to-middle cerebral artery bypass with a hinged bone flap:
Robert C Rennert1, Karol P Budohoski1, Ramesh Grandhi1
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT, 84132, USA.
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.
