Middle Meningeal-Middle Cerebral Artery Anastomosis for Moyamoya Disease

BACKGROUND: We describe a unique anastomosis procedure involving successful middle meningeal artery (MMA) to cortical middle cerebral artery (MCA) bypass, as well as superficial temporal artery (STA) to cortical MCA bypass. CASE DESCRIPTION: A 46-year-old woman with hemorrhagic Moyamoya disease underwent an anastomosis procedure with the MMA and STA serving as donor arteries. We performed a small craniotomy at the areas closest to the donor STA, MMA, and recipient cortical MCA, and completed STA-MCA and MMA-MCA direct bypass procedures. CONCLUSIONS: This is a rare case of successful MMA-to-MCA revascularization to prevent rebleeding in a patient with Moyamoya disease. The MMA can be used as a donor artery for extracranial-intracranial anastomosis procedures in clinical practice settings.