Direct double bypass using the posterior auricular artery as initial surgery for moyamoya disease: technical note

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  • Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan
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Surgical treatments for moyamoya disease (MMD) include direct revascularization procedures with proven efficacy, for example, superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, STA to anterior cerebral artery bypass, occipital artery (OA) to MCA bypass, or OA to posterior cerebral artery bypass. In cases with poor development of the parietal branch of the STA, the posterior auricular artery (PAA) is often developed and can be used as the bypass donor artery. In this report, the authors describe double direct bypass performed using only the PAA as the donor in the initial surgery for MMD.

In the authors’ institution, MMD is routinely treated with an STA-MCA double bypass. Some patients, however, have poor STA development, and in these cases the PAA is used as the donor artery. The authors report the use of the PAA in the treatment of 4 MMD patients at their institution from 2013 to 2016. In all 4 cases, a double direct bypass was performed, with transposition of the PAA as the donor artery. Good patency was confirmed in all cases via intraoperative indocyanine green angiography and postoperative MRA or cerebral angiography. The mean blood flow measurement during surgery was 58 ml/min. No patients suffered a stroke after revascularization surgery.

ABBREVIATIONS ICGA = indocyanine green angiography; MCA = middle cerebral artery; MMD = moyamoya disease; PAA = posterior auricular artery; STA = superficial temporal artery.

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Contributor Notes

Correspondence Koji Yamaguchi: Tokyo Women’s Medical University, Tokyo, Japan. yamaguchi.koji@twmu.ac.jp.

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.5.JNS19173.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Fujimura M, Funaki T, Houkin K, Takahashi JC, Kuroda S, Tomata Y, : Intrinsic development of choroidal and thalamic collaterals in hemorrhagic-onset moyamoya disease: case-control study of the Japan Adult Moyamoya Trial. J Neurosurg 130:14531459, 2019

    • Search Google Scholar
    • Export Citation
  • 2

    Funaki T, Takahashi JC, Houkin K, Kuroda S, Takeuchi S, Fujimura M, : Angiographic features of hemorrhagic moyamoya disease with high recurrence risk: a supplementary analysis of the Japan Adult Moyamoya Trial. J Neurosurg 128:777784, 2018

    • Search Google Scholar
    • Export Citation
  • 3

    Funaki T, Takahashi JC, Houkin K, Kuroda S, Takeuchi S, Fujimura M, : High rebleeding risk associated with choroidal collateral vessels in hemorrhagic moyamoya disease: analysis of a nonsurgical cohort in the Japan Adult Moyamoya Trial. J Neurosurg 130:525530, 2019

    • Search Google Scholar
    • Export Citation
  • 4

    Germans MR, Regli L: Posterior auricular artery as an alternative donor vessel for extracranial-intracranial bypass surgery. Acta Neurochir (Wien) 156:20952101, 2014

    • Search Google Scholar
    • Export Citation
  • 5

    Horiuchi T, Kusano Y, Asanuma M, Hongo K: Posterior auricular artery-middle cerebral artery bypass for additional surgery of moyamoya disease. Acta Neurochir (Wien) 154:455456, 2012

    • Search Google Scholar
    • Export Citation
  • 6

    Ishikawa T, Yamaguchi K, Kawashima A, Funatsu T, Eguchi S, Matsuoka G, : Predicting the occurrence of hemorrhagic cerebral hyperperfusion syndrome using regional cerebral blood flow after direct bypass surgery in patients with moyamoya disease. World Neurosurg 119:e750e756, 2018

    • Search Google Scholar
    • Export Citation
  • 7

    Kawashima A, Kawamata T, Yamaguchi K, Hori T, Okada Y: Successful superficial temporal artery-anterior cerebral artery direct bypass using a long graft for moyamoya disease: technical note. Neurosurgery 67 (3 Suppl Operative):ons145ons149, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Kuroda S, Houkin K: Bypass surgery for moyamoya disease: concept and essence of sugical techniques. Neurol Med Chir (Tokyo) 52:287294, 2012

    • Search Google Scholar
    • Export Citation
  • 9

    Miyamoto S, Yoshimoto T, Hashimoto N, Okada Y, Tsuji I, Tominaga T, : Effects of extracranial-intracranial bypass for patients with hemorrhagic moyamoya disease: results of the Japan Adult Moyamoya Trial. Stroke 45:14151421, 2014

    • Search Google Scholar
    • Export Citation
  • 10

    Nomura S, Yamaguchi K, Ishikawa T, Kawashima A, Okada Y, Kawamata T: Factors of delayed hyperperfusion and the importance of repeated cerebral blood flow evaluation for hyperperfusion after direct bypass for moyamoya disease. World Neurosurg 118:e468e472, 2018

    • Search Google Scholar
    • Export Citation
  • 11

    Okada Y, Shima T, Yamane K, Yamanaka C, Kagawa R: Cylindrical or T-shaped silicone rubber stents for microanastomosis—technical note. Neurol Med Chir (Tokyo) 39:5558, 1999

    • Search Google Scholar
    • Export Citation
  • 12

    Rutledge WC, Choudhri O, Walcott BP, Benet A, Fox CK, Gupta N, : Indirect and direct revascularization of ACTA2 cerebral arteriopathy: feasibility of the superficial temporal artery to anterior cerebral artery bypass with posterior auricular artery interposition graft: case report. J Neurosurg Pediatr 18:339343, 2016

    • Search Google Scholar
    • Export Citation
  • 13

    Takahashi JC, Funaki T, Houkin K, Inoue T, Ogasawara K, Nakagawara J, : Significance of the hemorrhagic site for recurrent bleeding: prespecified analysis in the Japan Adult Moyamoya Trial. Stroke 47:3743, 2016

    • Search Google Scholar
    • Export Citation
  • 14

    Tokugawa J, Nakao Y, Kudo K, Iimura K, Esaki T, Yamamoto T, : Posterior auricular artery-middle cerebral artery bypass: a rare superficial temporal artery variant with well-developed posterior auricular artery—case report. Neurol Med Chir (Tokyo) 54:841844, 2014

    • Search Google Scholar
    • Export Citation
  • 15

    Tokugawa J, Ogura K, Yatomi K, Kudo K, Hishii M, Tanikawa R, : Bipolar cutting method: Another technique for harvesting donor artery with histological investigation. Oper Neurosurg (Hagerstown) 14:1619, 2018

    • Search Google Scholar
    • Export Citation
  • 16

    Torazawa S, Hasegawa H, Kin T, Sato H, Sora S: Long-term patency of posterior auricular artery-middle cerebral artery bypass for adult-onset moyamoya disease: case report and review of literature. World Neurosurg 108:994.e1994.e5, 2017

    • Search Google Scholar
    • Export Citation

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