Wide Arterial Sparing Encephalo-Duro-Synangiosis for Moyamoya: Surgical Technique and Outcomes

Demi Dawkins, Beverly Aagaard-Kienitz, Kelly Capel, Laura Eisenmenger, Alexey Samsonov, Yiping Li, Carolina Sandoval-Garcia, Bermans Iskandar

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND: Moyamoya is managed by surgical revascularization, but no standardized method has yet been universally adopted. OBJECTIVE: To describe a new indirect bypass technique for pediatric moyamoya, wide arterial sparing encephalo-duro-synangiosis (WASEDS), which provides a much wider area of revascularization with minimal compromise to the middle meningeal arterial tree compared with traditional procedures. Initially used as a salvage technique after failed encephalo-duro-arterio-synangiosis, its success later motivated its use as a first-line procedure. METHODS: Clinical and radiographic records of patients who underwent WASEDS for moyamoya from 2009 to 2020 were reviewed. Brain perfusion relative cerebral blood volume on the side of the WASEDS procedure was calculated. Two-tailed paired t tests were performed to identify the statistically significant differences (P ≤ .05). RESULTS: WASEDS was successfully performed on 8 patients for a total of 14 cerebral hemispheres. Age ranged from 2 to 25 years. There were no mortalities. The average clinical and radiographic follow-up was 49.79 months (range 2-126 months), demonstrating improvement in neurological condition and no postoperative stroke and significant diminution or cessation of transient ischemic attacks in all patients. Relative cerebral blood volume increased 9.24% after the WASEDS procedure (P = .012). There were no neurological complications. There were 2 pseudomeningoceles related to the extensive dural openings. CONCLUSION: WASEDS is a safe and effective indirect revascularization technique for both primary and salvage techniques. It provides an extensive area of cortical revascularization with no compromise of the middle meningeal vasculature and subjective reports of early improvement in cognition and behavior. The main disadvantage is elevated risk of pseudomeningocele secondary to the large craniotomy.

Original languageEnglish (US)
Pages (from-to)489-498
Number of pages10
JournalOperative Neurosurgery
Issue number6
StatePublished - Dec 16 2022

Bibliographical note

Publisher Copyright:
Copyright © Congress of Neurological Surgeons 2022. All rights reserved.


  • Direct bypass
  • Encephalo-duro-synangiosis
  • Indirect bypass
  • Moyamoya


Dive into the research topics of 'Wide Arterial Sparing Encephalo-Duro-Synangiosis for Moyamoya: Surgical Technique and Outcomes'. Together they form a unique fingerprint.

Cite this