[Strategy for vascular reconstruction for failed indirect anastomosis in adult Moyamoya disease--a case report].

There exist moyamoya disease patients who require vascular reconstruction for failed indirect anastomosis. In the present study, a 36-year-old female required ipsilateral direct anastomosis for failed right fronto-temporo-parietal combined indirect bypass procedure. One of the frontal branches of the right superficial temporal artery (STA) was left intact between the other frontal branch and a parietal branch of the right STA, both of which had been used in the indirect anastomosis. The intact STA was used for direct anastomosis, and craniotomy was performed between the two craniotomy sites of the first operation. Methods of the direct anastomosis for the failed indirect anastomosis should be discussed in each patient who requires vascular reconstruction for failed indirect anastomosis.