Multiple EDAS (encephalo-duro-arterio-synangiosis). Additional EDAS using the frontal branch of the superficial temporal artery (STA) and the occipital artery for pediatric moyamoya patients in whom EDAS using the parietal branch of STA was insufficient.

Although parietal EDAS or STA-MCA anastomosis are effective in pediatric moyamoya disease, they do not adequately prevent ischemia in the frontal and occipital lobes. Some additional methods that can prevent ischemia in the frontal and occipital lobes are sometimes needed. We investigated whether EDAS using a frontal branch of the superficial temporal artery (frontal EDAS) or EDAS using the occipital artery (occipital EDAS) is preferable. Frontal or occipital EDAS was performed at 15 sites in seven patients with pediatric moyamoya disease. The outcome was estimated by angiography 3 months later, CT findings 3 months later, neurological findings during the follow up period and perioperative complications. The mean follow up period was 14 +/- 6 months after frontal or occipital EDAS. As results, good revascularization from frontal or occipital EDAS was shown in ten of fourteen surgical sites (71%) in angiography. None of the patients showed deterioration of symptoms after frontal or occipital EDAS during the follow up period. None of the patients developed surgical complications. In conclusion, multiple EDAS using the frontal branch of STA and the occipital artery is an effective and safe method for preventing ischemia in the frontal and occipital lobe in pediatric moyamoya disease.