Anastomosis of the superficial temporal artery to the middle cerebral artery with the interposed occipital artery graft in moyamoya disease: case report

Abstract

Background: Although there have been various interposed bypass grafts used for cerebral revascularization, the occipital artery has never been used as a graft. Interposed occipital artery bypass graft in an adult case with moyamoya disease after failed indirect revascularization is presented.

Case description: This 34-year-old woman with moyamoya disease, who had suffered from cerebral ischemic symptoms since the age of 6 years, was admitted to our hospital because of an intracerebral hemorrhage on the left side. She had undergone superficial temporal-to-middle cerebral artery anastomosis, encephalo-galeo-synangiosis on the right side, and encephalo-duro-arterio-synangiosis on the left side at age 29 years. Four months after the intracerebral hemorrhage, she still had cerebral ischemic symptoms in the left hemisphere where cerebral revascularization was poor. Since neither the superficial temporal nor occipital artery could be used for direct anastomosis because of spontaneous transdural anastomoses of the superficial temporal artery and the short length of the occipital artery, anastomosis between the left superficial temporal artery and left posterior parietal artery was performed using a left occipital artery graft 6 months after the hemorrhage. Postoperative external carotid angiograms showed good patency of the graft.

Conclusion: In cases in which direct anastomosis is infeasible for cerebral revascularization, the occipital artery could successfully be used as a bypass graft.