View article

● Indirect revascularization techniques emerged as an alternative treatment option for moyamoya disease due to technical difficulties associated with direct superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis as well as the accessibility and small size of the STA, especially in children. Encephalomyosynangiosis (EMS) was first proposed by Karasawa et al in 1977, and the other forms of indirect method followed: EDAS (encephaloduroarteriosynangiosis) by Matsushima in 1981, and EDAMS (encephaloduroarteriomyosynangiosis) by Kinugasa in 1993.

● Moyamoya disease is a chronic cerebrovascular disorder characterized by progressive occlusion of the intracranial vessels. As the stenosis progresses to the level of complete occlusion, a dense collateral network of abnormal neovascularity develops at the base of the skull, giving an angiographic appearance of a hazy “puff of smoke”(moyamoya in Japanese).