ArticleSurgical neurology international2025
Encephaloduroarteriomyosynangiosis with the middle meningeal artery for proliferative cerebral angiopathy treatment: A case report.
Article in Surgical neurology international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Cerebral proliferative angiopathy (CPA) is a rare vascular disorder characterized by diffuse vascular networks intermingled with functional brain tissue, lacking a well-defined nidus. Unlike classical arteriovenous malformations, CPA often involves bilateral arterial supply, fragile neovessels, and hemodynamic instability, posing significant therapeutic challenges. Case Description: We report an 18-year-old female with progressive neurological decline, focal seizures, and imaging findings consistent with CPA. Magnetic resonance imaging revealed diffuse vascular anomalies in the left hemisphere, while digital subtraction angiography demonstrated bilateral internal carotid supply with no dominant feeder or nidus. Given her recurrent ischemic symptoms, indirect revascularization was indicated. Intraoperatively, superficial temporal artery thrombosis was identified, prompting an alternative arachnoid synangiosis using the middle meningeal artery (MMA). A tailored encephaloduroarteriomyosynangiosis was performed. At 12-month follow-up, the patient showed significant clinical and radiological improvement, including motor function recovery, seizure control, and reduced cortical congestion on imaging. Conclusion: This case highlights the feasibility of synangiosis using the MMA as an alternative donor artery for indirect cerebral revascularization in CPA when standard extracranial vessels are compromised. Surgical revascularization may offer functional recovery in selected cases with progressive symptoms. Given the uncertainty of long-term outcomes, prospective cohort studies may be required to validate this approach.
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