Pedicled temporoparietal fascial flap for combined revascularization in adult moyamoya disease

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Moyamoya disease (MMD) is a progressive, idiopathic cerebrovascular occlusive disease. Various revascularization techniques including direct, indirect, and combined microvascular bypasses have been described. This article presents a modified revascularization technique for MMD utilizing a pedicled temporoparietal fascial flap (TPFF) for combined revascularization. This technique combines a large area of coverage for indirect revascularization with the benefits of a direct bypass. The pedicled TPFF also benefits from intact venous drainage to minimize the risk of flap swelling that could result in complications from mass effect.

ABBREVIATIONS EC-IC = extracranial-to-intracranial; ICA = internal carotid artery; MCA = middle cerebral artery; MMD = moyamoya disease; STA = superficial temporal artery; STV = superficial temporal vein; TPF = temporoparietal fascia; TPFF = temporoparietal fascial flap.
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Correspondence Jonathan J. Russin: The Keck School of Medicine, University of Southern California, Los Angeles, CA. jonathan.russin@med.usc.edu.INCLUDE WHEN CITING Published online November 9, 2018; DOI: 10.3171/2018.5.JNS18938.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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