• Yusuke Egashira, Shinichi Yoshimura, Yukiko Enomoto, Noriyuki Nakayama, and Toru Iwama.
• Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Japan. Electronic address: egashi@gifu-u.ac.jp.
• World Neurosurg. 2018 Oct 1; 118: 324-328.

ObjectiveThe authors present cases of childhood moyamoya disease successfully treated with bilateral superficial temporal artery to anterior cerebral artery (ACA) direct anastomoses and describe the surgical techniques used in this vascular reconstruction method.MethodsThe authors conducted bilateral superficial temporal artery to ACA anastomoses, combined with indirect bypass in 3 pediatric patients with moyamoya disease from 2009 to 2015. All 3 patients presented with transient ischemic attacks related to ischemia of the ACAs and had cerebral blood flow insufficiency, predominantly in the ACA regions bilaterally.ResultsIn all 3 cases, ischemic symptoms corresponding to ACA ischemia had disappeared after bypass surgery. No patients experienced any postoperative neurologic or wound complications associated with the procedure. Improvement of cerebral blood flow in bilateral ACA territories and the patency of the direct bypasses were confirmed by follow-up imaging in all 3 patients.ConclusionsThe described technique can be considered an effective and uncomplicated revascularization procedure for the ACA regions, which are crucial for normal intellectual growth in the pediatric population.Copyright © 2018 Elsevier Inc. All rights reserved.

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