Encephaloduroarteriosynangiosis (EDAS) in a 31-Year-Old Filipino Female with Moyamoya Disease: A Case Report
DOI:
https://doi.org/10.47363/JNRRR/2026(8)254Keywords:
Encephaloduroarteriosynangiosis, Moyamoya Disease, Revascularization, STAp (Superficial Temporal Artery Parietal Branch)Abstract
Introduction: Adult Moyamoya Disease is a rare chronic cerebrovascular disorder presenting with narrowed or stenotic vasculatures presenting as hemorrhagic stroke in adults. In the Philippines, stroke is a leading cause of death and disability in adult population.
Objectives: This case report aims to discuss the course and clinical outcome of an adult with Moyamoya Disease who underwent Encephaloduroarteriosynangiosis (EDAS) for indirect revascularization and explore decision points for such surgical management.
Case: The index patient is a 31-year-old female who presented with headache, visual disturbances, right-sided weakness, anterograde amnesia, retrograde amnesia, and cognitive impairment. Patient had severe cognitive impairment, no light perception on both eyes, with right hemiparesis of 4/5 motor strength. Preoperatively, patient was prepared for a double set-up direct and/or indirect revascularization technique (STA-MCA Bypass surgery and/or EDAS) however intraoperatively there was a note of 0.6-0.7mm diameter of the left parietal branch of the Superficial Temporal Artery which led to the decision to perform indirect revascularization i.e., Left Encephaloduroarteriosynangiosis (EDAS).
Discussion: Adult cases are ideally managed using a combined approach of direct and indirect revascularization techniques. But for this case, the donor vessel was not suitable for STA-MCA bypass surgery hence the performance of EDAS. Collaterals from EDAS were formed with the left side middle cerebral artery territory.
Conclusion: Multidisciplinary Approach plays a significant impact involving the Cerebrovascular Neurosurgeon, Endovascular Neurosurgeon, Neurologist, Neuroradiologist, Ophthalmologist, and Physiatrist in this field to define optimal screening and treatment strategies in patients with Moyamoya Disease. Six months after surgery, patient had improvements in the cognitive, neurologic status, radiographic, and functional outcome with modified Rankin Scale Score of 1. Patient remained stroke free since the time of the operation. Hence, indirect revascularization technique (EDAS) appears to be a safe and promising intervention even for adult patients with Moyamoya Disease.
