What is actually done during the surgical procedure “pial synangiosis” that you have recommended for my child?
This operation is designed to take advantage of the tendency of the brains of children with moyamoya syndrome to attract new blood vessels from any source that is made available. We make an incision on the scalp over an artery supplying blood only to the skin over the head. We separate this artery from the tissues around it, keeping blood flowing through it. We open up a window of bone beneath the artery, and then use a microscope to carefully open all of the coverings of the brain right down to the brain surface. The artery is then placed directly onto the brain, and the tissues around its walls are sewn with tiny sutures to the brain surface to keep it in contact with the brain. Then the bone window is replaced securely, and the skin incision closed. In some patients, we may also place an extra small hole (a “burr hole”) in the skull away from the first incision, and at this hole we also make tiny openings in all of the coverings of the brain before closing the incision. To operate o
