Ribbon enchephalo-duro-arterio-myo-synangiosis for moyamoya disease

Kazushi Kinugasa, Shinya Mandai, Koji Tokunaga, Ichiro Kamata, Kenji Sugiu, Akira Handa, Takashi Ohmoto

Research output: Contribution to journalArticlepeer-review

73 Citations (Scopus)


In patients with advanced moyamoya disease, reconstructive surgery alone may not prevent the deterioration of blood flow in the territory of the anterior cerebral artery. These types of surgery include superficial temporal artery-to-middle cerebral artery anastomosis and encephalo-duro-arterio-myo-synangiosis (EDAMS). Bilateral encephalo-duro-arterio-synangiosis (EDAS) gradually reduced the transient ischemic attacks in one of our patients who experienced motor weakness in the left extremities. After surgery, however, persistent bilateral attacks still occurred in the patient's legs. In a subsequent maneuver, we inserted the pedicle of the galea on both sides into the interhemispheric fissure, which induced marked vascularization in the territory of the anterior cerebral artery, and the attacks disappeared. Since then, we have combined this "ribbon" technique with EDAMS to treat eight patients with moyamoya disease. Postoperative angiograms showed widespread collateral circulation on the ischemic brain surface in six patients undergoing ribbon EDAS or EDAMS. Postoperative measurements of cerebral blood flow revealed improved circulation in the frontal region in four patients. The clinical results were excellent in six patients, and good in one, and we lost follow-up in one. The ribbon EDAMS procedure is effective on moyamoya disease with symptomatic cerebral ischemia of the anterior circulation.

Original languageEnglish
Pages (from-to)455-461
Number of pages7
JournalSurgical neurology
Issue number6
Publication statusPublished - Jun 1994


  • Encephalo-duro-arterio-myo-synangiosis
  • Encephalo-duro-arterio-synangiosis
  • Middle meningeal artery
  • Moyamoya disease
  • Ribbon encephalo-duro-arterio-myosynangiosis
  • Superficial temporal artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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