intracranial and extracranial vascular communication

The principle of intracranial and extracranial vascular communication is to make the extracranial artery communicate with the cerebral vasculature. The difference between it and the intracranial and extravascular anastomosis is that the direct anastomosis of the intracranial and extracranial arteries is not performed, but the extracranial blood vessels are directly close to the brain surface. Later, it is connected between the intracranial and extravascular vessels, so that extracranial blood is supplied to the ischemic brain region to improve the blood supply state. Treating diseases: moyamoya disease, children's moyamoya disease Indication Intracranial and extracranial vascular communication is suitable for those in the cerebral ischemic area who are not suitable for anastomosis, such as moyamoya disease. Contraindications The patient's physical condition cannot tolerate the operator. Surgical procedure There are many methods for intracranial and extravascular communication, which are described as follows: 1. Encephalo-myo-synangiosis (EMS) The horseshoe-shaped incision of the ankle, the flap and the muscle flap are respectively turned downward, and the skull under the muscle flap is cut or drilled with a milling cutter. The bone window is about 5 cm×6 cm, and the dural is cut or excised radially, and the muscle flap is placed. Covered on the exposed brain surface, sutured on the dura mater under the bone window. Part of the lower edge of the bone piece is bitten to prevent the diaphragm from obstructing its blood supply. The edge of the bone piece is drilled, reset and fixed on the bone window, and the scalp is sutured according to the level. This surgery allows the diaphragm to be applied directly to the surface of the brain, and then communicates between the diaphragm and the cerebral vessels, allowing extracranial blood to be supplied to the ischemic brain. 2. Brain-dural-arterio-synangiosis (EDAS) In 1981, Matsushima was first created. (1) Cut the epidermis along the selected branch of the superficial temporal artery, but be careful not to injure the artery. (2) 5 mm along each side of the artery and parallel to the artery to cut the cap-shaped diaphragm to form a membranous strip containing the artery. (3) Drill a skull hole at each end of the incision and saw a bone bridge with a wire saw. (4) Cut or remove a dura mater. (5) suture the arterial-decidual strip on the dura mater to connect the artery to the surface of the brain. (6) The bone bridge is fixed and fixed. 3. Brain-dural-arterio-myo-synangiosis (EDAMS) In 1993, Kinugasa initiated this operation and combined EMS with EDAS. (1) The frontal scalp incision, but care should be taken not to cut the superficial temporal artery and separate the superficial temporal artery from the scalp. (2) The bone piece is removed freely to preserve the middle meningeal artery. (3) The dural incision is turned over to reveal the surface of the cerebral cortex. (4) Attach the superficial temporal artery strip to the surface of the brain and fix it. (5) The muscle piece and the dura mater are sutured and fixed to the surface of the brain, but sufficient space should be left to allow the superficial artery to pass without pressure. (6) The bone piece is reset, and the lower edge is removed to make the pedicle of the muscle piece unstressed. 4. Brain-muscle-vascular connection plus superficial temporal artery-brain artery anastomosis (EMS+STA-MCA) In order to supplement the blood supply of vascular connectivity and rapidly establish intracranial and extracranial vascular communication, EMS was combined with STA-MCA. (1) Ankle horseshoe-shaped incision, open the flap and dissipate the superficial temporal artery. (2) The bone piece is removed freely, and the lower edge part of the bone piece is bitten. (3) Incision of the dura mater and anastomosis of the superficial temporal artery and the middle cerebral artery. (4) The muscle piece covers the surface of the brain and is fixed. (5) The bone piece is fixed and fixed.