Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Biomolecular Insight Of Revascularization Surgery In Cerebrovascular Disease

Moyamoya disease is a progressive occlusive cerebrovascular disease of the intracranial internal carotid arteries or their proximal branches with compensatory development of a fine collateral network at the base of the brain (moyamoya vessels). Revascularization surgery is recognized as useful treatment for moyamoya disease. This treatment is believed to form vascular anastomoses between the extracranial tissue and the brain to supply blood flow to the ischemic tissue. Numerous surgical procedures exist for the treatment of moyamoya disease, including direct anastomosis such as superficial temporal artery (STA)–middle cerebral artery (MCA) anastomosis,4 indirect anastomosis such as encephaloduroarterio-synangiosis6 and encephalomyosynangiosis (EMS)5, and combined direct and indirect anastomosis.2 At several months after surgical treatment, the blood supply from the external carotid artery to intracranial vessels (MCA area) was generally confirmed by angiography in any kind of anastomosis. There are various patterns of revascularization depending on the dominancy of the donor arteries, such as STA, middle meningeal artery (MMA), or deep temporal artery. In the case of direct anastomosis, the STA grows larger and more robust than before surgery. In the case of indirect or combined anastomosis, the dominancy of the donor arteries varies in each case. Some cases showed dominant STA compared with the deep temporal artery or MMA. Others showed the same dominancy of the STA and MMA. A question emerges: What is the key factor that determines the dominancy or patency of the donor artery?