Intradural arteriosynagiosis in pediatric moyamoya disease: Modified technique of encephalo-duro-arterio-synangiosis with reduced operative damage to already growing revascularization

Objective: Various operative procedures have been described for the treatment of pediatric moyamoya disease. However, the majority of invasive or radical procedures proposed have focused primarily on revascularization and few have discussed to maximizing preservation of the already growing neovascular network. Methods: This present procedure describes the supratemporal artery is anastomosed to the inner layer of the dura mater and surrounded by the outer layer as a sandwich with a blunt procedure of dural layer separation. Results: This technique efficiently established an anastomotic connection between the supratemporal artery and the cortical brain, and the dura mater postoperatively with maximally preserving the existing vascular network. Conclusion: IDAS, the modified surgical technique of EDAS, shall be benefit in preserving the already developed colateral circulation, and underlying structure over the brain cortex as much as possible, which is important particularly in pediatric moyamoya patients.