164 K. Nishino et al.
anastomosis on the cortical surface or a transdural anastomosis via a vault or ethmoidal moyamoya.
Furthermore, it is also difficult to ascertain the detailed course of STA which is important information for harvesting STA for direct bypass.
165 MRI
mapping can be obtained by rapidly manipulating end-tidal PCO 2 between a hypercapnic and hypocapnic state (30–50 mmHg), and the map is capable of revealing the presence and spatial extent of exhausted autoregulation [13] .
Conclusions
Early diagnosis and appropriate treatment are crucial to improve the long-term outcome for cases with moyamoya disease. Although the imaging quality of MRI/MRA is still inferior to the existing modalities in some aspects, future progress of the technology will increase the role of MRI/MRA in the management of moyamoya disease.
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Fig. 8 Preoperative MRA (infero-lateral view ( a ), coronal view ( b )) shows occlusion in the terminal of bilateral ICA ( arrowheads ) and development of moyamoya vessels ( arrow ). MRA (infero-lateral view ( c ), coronal view ( d )) obtained 4 months after combined bypass surgery reveals an increase in the diameter of the superficial temporal artery and deep temporal arteries ( arrows ) as well as the remission of moyamoya vessels
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