Revascularization Procedures for Moyamoya Disease without Mayfield Skull Clamp

Abstract Moyamoya disease (MMD) is a pathophysiologically complex disorder characterized by progressive stenosis of the internal carotid arteries at the skull base and formation of circuitous and expanded collaterals angiographically “puff of smoke” at the base of brain. However, these collateral blood vessels are fragile and prone to ischemic or hemorrhagic events during the peri and intra-operative period. Direct and indirect bypass techniques have been devised with the goal of promoting angiogenesis, inducing formation of collateral vessels, and restoring perfusion to the oxygen deprived area of the brain. Mayfield skull clamp can cause blood pressure instability. This technical note highlights the surgical management of MMD without the use of Mayfield skull clamp with the goal of minimizing risk of perioperative blood pressure volatility.