Strategy for direct anastomosis in moyamoya disease

: Direct and/or indirect revascularization is usually performed in the surgical management of moyamoya disease. The surgical technique for direct anastomosis is thought to be difficult in some patients with moyamoya disease. In the present report, a more reliable technique for direct anastomosis is reported and demonstrated. Strategy for hemostatic procedure on the dura mater, preservation of fine branches originating from a recipient artery, opening of the recipient artery, and the technique for an anastomosis between a superficial temporal artery and a branch of the middle cerebral artery are discussed.