Actual Diagnosis

Moyamoya disease with watershed infracts in the right hemisphere and occlusion of the right M1 middle cerebral artery, high-grade stenosis of the right A1 anterior cerebral artery, and occlusion of the left supraclinoid internal carotid artery with moyamoya vessels bilaterally. SPECT cerebral blood flow study demonstrated a large territory of impaired hemodynamic reserve in the right hemisphere as well as some left-sided hemodynamic as well.

SURGERY #1

Surgery for revascularization of the right hemisphere - A 1.0mm diameter parietal branch of the superficial temporal artery was found as a donor. A 1.2mm diameter M4 branch of the middle cerebral artery emerging from the sylvian fissure on the frontal side was found as the recipient.

SURGERY #2

Surgery for revascularization of the left hemisphere - A 1.2mm diameter frontal branch of the superficial temporal artery was found as the donor. A 1.6mm diameter M4 branch of the middle cerebral artery emerging from the sylvian fissure on the frontal side was found as the recipient.