Surgical techniques and the results of a fronto-temporo-parietal combined indirect bypass procedure for children with moyamoya disease: a comparison with the results of encephalo-duro-arterio-synangiosis alone.

We recently treated children with Moyamoya disease using a fronto-temporo-parietal combined indirect bypass procedure. Three different indirect bypass procedures (frontal EMAS, EDAS, EMS) were simultaneously carried out at three different sites. We thus treated 16 sides in 12 pediatric patients with Moyamoya disease using this method. Both the collateral formation and the improvement in the clinical symptoms were evaluated postoperatively. These results were then compared with those of the patients treated by EDAS alone. The postoperative collateral formation was more extensively seen in the patients treated with the combined bypass procedure than in those treated by EDAS alone. The improvement in ischemic symptoms was also better in the patients treated by the combined indirect bypass procedure. We therefore conclude that the combined indirect bypass procedure is more effective than EDAS alone.