Assessment of encephalo-galeo-myo-synangiosis with dural pedicle insertion in childhood moyamoya disease: characteristics of cerebral blood flow and oxygen metabolism.

In the surgical treatment of childhood Moyamoya disease, we have been performing a new non-anastomotic bypass surgery using encephalo-galeo-myo-synangiosis (EGMS) with dural pedicle insertion over the brain surface. To assess the results obtained using this procedure, the long-term clinical outcome and the characteristics of cerebral blood flow and oxygen metabolism using PET were evaluated. The subjects were 19 patients with childhood Moyamoya disease admitted to our institution over 8 years from 1988 to 1996. This type of surgery was performed 39 times and the patients have been followed up from 10 months to 8 years. Preoperatively, although cerebral blood flow and oxygen metabolism were varied from individual to individual, low values of regional cerebral blood flow (rCBF) and regional cerebral metabolic rate of oxygen (rCMRO2) with relatively high values of regional oxygen extraction fraction (rOEF) were found in the frontal region in most of the patients compared to normal children. Postoperatively, obvious improvement of cerebral blood flow and hemodynamics in all the areas in the operative site and clinical symptoms and signs ameliorated or disappeared during the follow-up period. In conclusion, the present method appeared to be useful to improve the hemodynamic in the brain and its long-term clinical outcome was satisfactory.