1347. Use of the Posterior Auricular Artery for Indirect Bypass in Moyamoya

Authors: John Christopher Hawkins II, DO; Meg Ryan, BS; Sarah Graber, BS; Charles Wilkinson, MD (Normal, IL)

Introduction: Encephaloduroarteriosynangiosis (EDAS) for indirect revascularization of the brain in moyamoya disease and syndrome is predominantly performed using the superficial temporal artery (STA). We have at times used other branches of the external carotid artery (ECA) as the donor artery. In this study, we review our results using the posterior auricular artery (PAA) for EDAS to demonstrate that this artery can be successfully used for indirect bypass. Methods: We retrospectively reviewed all moyamoya patients at Children’s Hospital Colorado who underwent revascularization surgery from 2005 through 2017. We selected those who underwent EDAS using the posterior auricular artery and reviewed their presentation, anatomy, and radiologic and clinical outcomes. Results: Sixty-five moyamoya cases were screened in 45 subjects. We found three subjects who underwent EDAS using the PAA. They ranged from 3 to 17 years of age at surgery. There were two females and one male. One presented with a transient ischemic attack (TIA), one with postconcussive headaches and possible TIA, and one with unilateral lower extremity weakness and falls, incontinence and speech difficulty. One had a history of craniopharyngioma with radiation therapy and two had idiopathic moyamoya. In two subjects, the PAA was chosen for EDAS because there was no suitable parietal STA branch, and in one subject both the parietal STA branch and ipsilateral PAA were used for EDAS. All subjects had good radiologic revascularization of their brain from their PAA graft by catheter angiogram and/or magnetic resonance angiography. All subjects had improvement in their symptoms post-EDAS. None has had a post-EDAS stroke. Conclusion: The posterior auricular artery is a viable option for EDAS, and can be successfully used when the STA is not suitable as a donor artery or when an additional donor artery is desired.