Superficial temporal-middle cerebral artery anastomosis in Moyamoya disease

A 41-year-old Libyan woman with Moyamoya disease and persisting post-stroke neurological deficits was treated by a superficial temporal-middle cerebral artery (STA-MCA) anastomosis. The postoperative angiograms revealed that the STA was rapidly irrigating the territory of the middle cerebral artery including those regions that had been filled preoperatively via different networks of collaterals. Furthermore prompt venous drainage was seen to occur postoperatively. Following surgery EEG analyses revealed considerable increase in the electrical brain activity, and neurological examinations showed reversal of neurological deficits. The dependence of the postoperative neurological improvement on the increased cerebral blood supply through the new collateral channel could be demonstrated by the effect of temporary occlusion of the STA on the electrical brain activity.