POST-OPERATIVE BYPASS: Encephalodurosynangiosis

Case #1

    41 year old female with Moyamoya disease who currently presents with headache and episodes of falling down. An encephalodurosynangiosis (EDAS) procedure has been performed to increase intracranial blood supply. This procedure involves placement of superficial temporal artery branches against the dura (through a craniotomy defect) to facilitate development of collaterals to the middle cerebral artery. The collateral vessels are very small and generally would not be dangerous in an interventional procedure, although sacrifice of the superficial temporal artery in this patient could be catastrophic as is provides a significant amount of blood supply to the middle cerebral artery.

Lateral and AP views of a left common carotid angiogram are shown below. The left internal carotid artery is occluded. Multiple routes of collateral blood flow are present. The superficial temporal artery has been surgically attached to the dura and numerous small collateral vessels have formed which supply the middle cerebral artery. The middle meningeal artery is markedly enlarged and provides blood flow to the anterior cerebral artery via the anterior falx artery. The ophthalmic artery is filling retrograde predominately from ethmoidal branches of the internal maxillary artery.

Back to Post-operative bypass grafts

Back to Normal variants: Anterior falx artery enlargement