How I do it: combined bypass for adult moyamoya disease with maximal consideration of cosmetic aspects.

Abstract

Combined bypass, including direct and indirect procedures, has been recognized as the maximal revascularization to prevent further hemorrhagic or ischemic stroke in adult moyamoya disease (MMD). It is also important to consider cosmetic aspects when planning combined bypass for MMD. However, there are few reports that have described the cosmetic considerations in bypass surgery for MMD. We demonstrate our surgical techniques aimed at achieving extended revascularization as well as excellent cosmetic outcomes with figures and video. Our combined bypass procedures which focus on achieving maximal cosmetic results are effective methods that require no special instruments or techniques.