Perioperative complications of encephalo-duro-arterio-synangiosis: prevention and treatment.

We performed encephalo-duro-arterio-synangiosis on 169 sides of 81 Moyamoya and 8 non-Moyamoya patients in the past 10 years. The advantage of this operation is its minimal operative invasion, giving rise to few operative complications. During 10 years of practice, however, we encountered some perioperative problems. Perioperative cerebral infarction of varying severity was seen in six Moyamoya patients. Severe hyperventilation with crying was the main trigger of infarction. Two patients developed wound infection with Gram-negative rods. Removal of an infected bone flap was necessary. One Moyamoya patient developed malignant hyperthermia during the operation. One acute epidural hematoma necessitated an emergency hematoma removal. Five patients showed a temporary aggravation of involuntary movements. Prolonged mild fever and temporary and limited hair loss around the wound were often observed. Cases and their treatment are presented with discussion of preventive measures.