What is actually done during the surgical procedure “pial synangiosis?
This operation is designed to take advantage of the tendency of the brains of children with moyamoya syndrome to attract new blood vessels from any source that is made available by the surgeon. We make an incision on the scalp to expose a healthy blood vessel (the superficial temporal artery), and then separate it from the tissues around it, keeping blood flowing through it. We open up a window of bone beneath the artery, and then use a microscope to carefully open all of the coverings of the brain right down to the brain surface. The artery is then placed directly onto the brain, and the tissues surrounding its walls are sewn to the brain surface with tiny sutures to keep the artery in contact with the brain. Then the bone window is replaced securely, and the skin incision closed. To operate on one side of the brain takes about 3 to 4 hours; in many patients, we will try to do both sides of the brain on the same day, under the same anesthesia.
