Encephaloduroarteriosynangiosis
Neurosurgical procedure
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Procedure
A section of the superficial temporal artery and its surrounding tissue are carefully separated and preserved. After, a craniotomy is performed accessing the brain and exposing the dura mater through a small opening made in the skull. Then, the preserved artery is sutured to the edges of the dura mater and redirected onto the hypoxic portion of the brain's surface. The procedure is finished by reattaching the bone flap to the skull securing it with metal plates.
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Recovery
Over several weeks to a year, the body responds to the lack of blood flow by stimulating angiogenesis, which enables formation of new, healthy blood vessels from the placed artery onto the brain's surface.
Patients spend their first night in the ICU, where blood pressure is strictly monitored to prevent strokes while blood vessels regrow, followed by a few days in a regular neuroscience unit. Pain medication is optional, but usually provided to manage soreness and post-operative craniotomy headaches. Antiplatelet medications are typically provided to prevent blood clots during the recovery window.
Young children who undergo EDAS must be prevented from hyperventilation, as rapid breathing can trigger transient ischemic attacks before new blood vessels are fully grown.
Unlike most brain surgeries, EDAS generally does not require rehabilitation.