[Reconstructive operation of Moyamoya disease and its problems (author's transl)].

Cerebrovascular moyamoya disease is a chronic occlusive disease of unknown etiology, 90% of which are found among Japanese. At the 3rd International Symposium on Microsurgical Anastomosis held in 1976, Kikuchi and Kawasawa reported an preventing effect of STA-MCA bypass surgery for ischemic episode of this disease. Thereafter, they proposed a new operation to place temporal muscle on the brain surface, namely Encephalo-Myo Synangiosis (EMS), for the patients lacking suitable recipient artery of middle cerebral artery territory. The authors report clinical experience of eight STA-MCA anastomosis, two STA-MCA anastomosis with EMS and one EMS performed on six cases with moyamoya disease. The follow up period after operation ranged from seven to 18 months. Four patients had excellent results, and one good. One died of subdural hematoma of non-operated side seven months after contralateral bypass procedure. STA-MCA bypass surgery is an effective treatment for moyamoya disease. Also, EMS is expected to be a replaceable surgical procedure for STA-MCA bypass under absence of suitable recipient artery.