Last revised by Francis Deng on 6 May 2022

Encephalomyosynangiosis (EMS) is an indirect revascularization surgery for moyamoya disease as a way to bypass an occluded internal carotid artery and circle of Willis. 

It entails dissecting strips of vascularized temporalis muscle and subjacent galeal flap and, following craniotomy and opening the dura, laying them directly onto the pial surface of the brain. The dura is then closed over the muscle flap. Revascularization occurs as a result of angiogenesis driven by local hypoperfusion and ischemia 1. The deep temporal artery is the main arterial supply.

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