This is a 39-year-old, otherwise healthy woman who presented with right sided headaches for several months’ duration.
MRI was performed and did not reveal a stroke or hemorrhage but suggested a paucity of vasculature in the right intracranial circulation and a diagnosis of Moya-Moya, prompting a referral to NSPC’s neurovascular surgeon Dr. Jonathan Brisman.
Noninvasive vascular imaging was sufficiently suggestive to warrant conventional digital subtraction angiography, performed by Dr. Brisman and confirming Moya-Moya syndrome (Figures 1). CT Perfusion (Figure 2) showed a decreased transit time of blood to the right hemisphere and the patient was recommended to undergo cerebral revascularization to avert stroke.
A right sided Encephaloduroarteriosynagios (EDAS) procedure was undertaken in which the right superficial temporal artery (STA) is sewn (synangiosed) to the pia in an effort to generate vascular arborization and increased blood flow to the hemisphere (Figure 3).
The surgery was uneventful, and the patient was restarted on her aspirin one day later and discharged home on postoperative day #2 neurologically intact.
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