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View full-text article in PMC

. 2020 Aug 20;144:e277–e284. doi: 10.1016/j.wneu.2020.08.114

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A 41-year-old female patient with moyamoya disease presented with repeated transient ischemic attacks, and catheter angiogram (A) showed severe internal carotid artery narrowing with classic moyamoya disease vessel appearance (asterisk). She underwent left double-barrel superficial temporal artery−middle cerebral artery (MCA) bypass; intraoperative images are shown before (B), after the 2 anastomoses (C), and after indocyanine green angiography (D). (E−G) After the size of the PMMA cranioplasty was outlined, the implant was cut out using a craniotomy (E) and fixated using titanium plates and screws (G). Postoperative catheter angiogram (H) confirmed bypass patency (asterisk), and postoperative CTA in coronal reconstruction showed the PMMA implant and the patent bypass graft (I). Transcranioplasty Doppler ultrasound confirmed flow and bypass patency as well (J and K). 1 asterisk, frontal M4 MCA branch, 2 asterisks, temporal M4 MCA branch; c, PMMA implant; fSTA, frontal STA branch; pSTA, parietal STA branch.