[Neovascularization after encephalo-duro-arterio-synangiosis in elderly quasi-moyamoya disease: a case report].

A 65-year-old man who had a history of diabetes mellitus visited a hospital for recent memory disturbance. MR angiography showed stenoses of the main trunks of the intracranial arteries. He was admitted to our hospital, and angiography revealed occlusion of the left cervical internal carotid and right middle cerebral arteries, and stenoses of the right internal carotid, right anterior cerebral, left vertebral, and right posterior cerebral arteries. There was collateral circulation formed from the left external carotid and left posterior cerebral arteries. Basal moyamoya vessels were also observed. 123I-IMP SPECT showed low perfusion of the right cerebral hemisphere, and response to acetazolamide was poor. Based on the angiographical findings and the presence of diabetes mellitus, the patient was diagnosed as having quasi-moyamoya disease. Vascular reconstructive surgery was indicated. Since there was no recipient artery adequate for STA-MCA anastomosis, encephalo-duro-arterio-synangiosis was performed on the right side. Postoperatively, the patient's recent memory improved gradually, and angiography performed 7 months after the operation revealed neovascularization from the superficial and deep temporal arteries. Although indirect bypass surgery has been applied mainly to child moyamoya disease, its effectiveness for cerebral ischemia in adult patients has also been reported, particularly in cases with misery perfusion. Neovascularization with indirect bypass surgery can be expected if the patient is under misery perfusion, even in elderly patients.