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¹Recep Tayyip Erdoğan Üniversitesi, Rize Eğitim Araştırma Hastanesi, Nöroşirürji Anabilim Dalı, Rize, Türkiye
²Catholic University, Medical School, Pediatric Neurosurgery Department, Roma, İtalya Moyamoya disease is a chronic occlusive cerebrovascular disease characterized by bilateral stenosis of the internal carotid arteries. There is still no known definitive treatment which prevents progression of the disease but appropriate by-pass methods are tried to prevent ischemic injuries. An 8-year-old boy with complaints of headache and focal epileptic seizures was diagnosed as Moyamoya disease after cerebral angiography. Encephalo-myo-synangiosis (EMS) surgery with three burr-holes was performed to both two hemispheres of the patient with an interval of 3 months. Cerebral arterial circulation was observed with classical cerebral angiography 1 year after last intervention. New vascular structures formed between the external and internal carotid arteries were observed. This is presented as proof of how angiogenesis after indirect bypass is eff ective in pediatric cases. Considering the angiographic findings, we believe that the EMS surgery will be the first choice of treatment in pediatric cases with Moyamoya disease as it is easy to perform, less invasive, performed in a shorter time and has fewer perioperative complications. Anahtar Kelimeler : Direct anastomosis, Encephalo-myo-synangiosis, Indirect anastomosis, Moyamoya disease, Re-vascularization