Moyamoya disease associated with bilateral occlusion of the vertebral artery

An unusual case of moyamoya disease associated with bilateral occlusion of the vertebral artery is reported. This case shows several embryologic collateral channels, which are typical of moyamoya disease, around the brainstem, that is, a transdural anastomosis between the superior cerebellar artery and the posterior meningeal artery, a leptomeningeal anastomosis between the superior cerebellar artery and the posterior inferior cerebellar artery, and moyamoyalike collateral vessels via primitive lateral anastomotic channels of Padget . Bilateral encephalomyosynangiosis (temporal muscle graft) were performed. Postoperatively, no ischemic attacks have developed for 6 years.