Revascularization Surgery for Moyamoya Disease with Cerebral Ischemia in Temporo-occipital Lobes

We report a novel surgical technique for patients with profound cerebral ischemia in the temporo-occipital lobes due to significant stenosis of the ipsilateral posterior cerebral artery (PCA) in moyamoya disease. The technique includes STA-MCA anastomosis targeted to the angular artery and indirect bypass through large craniotomy extended towards the temporo-parietal area. Over the past 10 years, we applied the surgical technique for 4 patients who exhibited transient ischemic attacks or ischemic stroke involving the temporo-occipital lobes. Following surgery, none of them developed any cerebrovascular events during follow-up periods of up to 8 years. Cerebral angiography revealed that surgical collaterals widely supplied blood flow to the operated hemispheres, including the posterior temporal and parietal lobes. Postoperative SPECT and/or PET studies also demonstrated marked improvement of cerebral hemodynamics and metabolism in the operated hemispheres, including the occipital lobe. The presented surgical technique can effectively improve cerebral hemodynamics and metabolism in the frontal, temporal, and occipital lobes at once in patients with cerebral ischemia in the temporo-occipital lobes due to PCA stenosis in moyamoya disease