What is an encephaloduroarteriosynangiosis procedure?
It is a surgical procedure that transposes a segment of a scalp artery onto the surface of the brain to improve collateral blood flow. (Ross et al.)
Which arteries create the "puff of smoke" appearance?
The lenticulostriate and thalamic perforating arteries.
Contrast injection into the right common carotid artery reveals complete occlusion of right internal carotid artery in neck at the level of bifurcation. A small stump is identified. Occluded right internal carotid artery, middle cerebral artery, and anterior cerebral artery with prominent lenticulostriate arteries. Evidence of craniotomy and poor visualization of STA to MCA bypass may indicate previous encephaloduroarteriosynangiosis.
Moyamoya is seen with occlusion of bilateral internal carotid arteries at the level of the carotid bifurcation in the neck. Prominent lenticulostriate and thalamic perforating arteries noted.
Unsubtracted images included for orientation.