{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T16:32:40Z","timestamp":1789057960213,"version":"build-2803163510"},"reference-count":7,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:00:00Z","timestamp":1759536000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:00:00Z","timestamp":1759536000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum D\u00fcsseldorf. Anstalt \u00f6ffentlichen Rechts"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Extracranial-intracranial (EC-IC) bypass is an effective revascularization technique for flow augmentation in conditions like Moyamoya disease and ischemic cerebrovascular disorders. The approach described here combines direct bypass (STA-MCA anastomosis), indirect bypass (encephaloduromyosynangiosis, EDMS), preservation of the middle meningeal artery (MMA), and preservation of recipient artery perforators to optimize outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Method<\/jats:title>\n            <jats:p>This article outlines a comprehensive surgical strategy emphasizing anatomical considerations, procedural nuances, and the integration of direct and indirect techniques while preserving MMA and recipient artery perforators to augment collateral circulation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The Integrated Method described here encompasses four technical aspects so as to enhance revascularization, minimize complications, and improve long-term outcome in carefully selected patients.\n<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06689-z","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T07:12:56Z","timestamp":1759561976000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["How I do it \u2013 extracranial-intracranial bypass surgery integrating STA-MCA anastomosis, synangiosis, MMA supply, and preservation of recipient artery perforators: the Integrated Method"],"prefix":"10.1007","volume":"167","author":[{"given":"Milad","family":"Neyazi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv Kumar","family":"Khajuria","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Faust","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajjad","family":"Muhammad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,4]]},"reference":[{"issue":"4","key":"6689_CR1","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1007\/s10143-020-01393-1","volume":"44","author":"P Fiaschi","year":"2021","unstructured":"Fiaschi P, Scala M, Piatelli G, Tortora D, Secci F, Cama A, Pavanello M (2021) Limits and pitfalls of indirect revascularization in moyamoya disease and syndrome. Neurosurg Rev 44(4):1877\u20131887. https:\/\/doi.org\/10.1007\/s10143-020-01393-1","journal-title":"Neurosurg Rev"},{"issue":"1","key":"6689_CR2","doi-asserted-by":"publisher","first-page":"64","DOI":"10.3171\/2014.12.PEDS14522","volume":"16","author":"CJ Griessenauer","year":"2015","unstructured":"Griessenauer CJ, Lebensburger JD, Chua MH, Fisher WS, Hilliard L, Bemrich-Stolz CJ, Howard TH, Johnston JM (2015) Encephaloduroarteriosynangiosis and encephalomyoarteriosynangiosis for treatment of moyamoya syndrome in pediatric patients with sickle cell disease. J Neurosurg Pediatr 16(1):64\u201373. https:\/\/doi.org\/10.3171\/2014.12.PEDS14522","journal-title":"J Neurosurg Pediatr"},{"issue":"5","key":"6689_CR3","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.wneu.2015.01.016","volume":"83","author":"H Imai","year":"2015","unstructured":"Imai H, Miyawaki S, Ono H, Nakatomi H, Yoshimoto Y, Saito N (2015) The importance of encephalo-myo-synangiosis in surgical revascularization strategies for moyamoya disease in children and adults. World Neurosurg 83(5):691\u2013699. https:\/\/doi.org\/10.1016\/j.wneu.2015.01.016","journal-title":"World Neurosurg"},{"issue":"6","key":"6689_CR4","doi-asserted-by":"publisher","first-page":"1411","DOI":"10.3171\/2014.7.JNS132793","volume":"121","author":"K Kono","year":"2014","unstructured":"Kono K, Terada T (2014) Encephaloduroarteriosynangiosis for cerebral proliferative angiopathy with cerebral ischemia. J Neurosurg 121(6):1411\u20131415. https:\/\/doi.org\/10.3171\/2014.7.JNS132793","journal-title":"J Neurosurg"},{"issue":"12","key":"6689_CR5","doi-asserted-by":"publisher","first-page":"3572","DOI":"10.1161\/STROKEAHA.122.039584","volume":"53","author":"VN Nguyen","year":"2022","unstructured":"Nguyen VN, Motiwala M, Elarjani T, Moore KA, Miller LE, Barats M, Goyal N, Elijovich L, Klimo P, Hoit DA, Arthur AS, Morcos JJ, Khan NR (2022) Direct, indirect, and combined extracranial-to-intracranial bypass for adult Moyamoya disease: an updated systematic review and meta-analysis. Stroke 53(12):3572\u20133582. https:\/\/doi.org\/10.1161\/STROKEAHA.122.039584","journal-title":"Stroke"},{"issue":"1","key":"6689_CR6","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1055\/s-2005-868160","volume":"15","author":"ER Smith","year":"2005","unstructured":"Smith ER, Scott RM (2005) Surgical management of moyamoya syndrome. Skull Base 15(1):15\u201326. https:\/\/doi.org\/10.1055\/s-2005-868160","journal-title":"Skull Base"},{"key":"6689_CR7","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.wneu.2016.04.083","volume":"92","author":"H Sun","year":"2016","unstructured":"Sun H, Wilson C, Ozpinar A, Safavi-Abbasi S, Zhao Y, Nakaji P, Wanebo JE, Spetzler RF (2016) Perioperative complications and long-term outcomes after bypasses in adults with Moyamoya disease: a systematic review and meta-analysis. World Neurosurg 92:179\u2013188. https:\/\/doi.org\/10.1016\/j.wneu.2016.04.083","journal-title":"World Neurosurg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06689-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06689-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06689-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T07:12:56Z","timestamp":1759561976000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06689-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,4]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6689"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06689-z","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,4]]},"assertion":[{"value":"27 May 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study complies with ethical guidelines, and patients provided informed consent for the use of images.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Compliance with ethical standards"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"In the preparation of this manuscript, artificial intelligence (AI) tools, specifically OpenAI\u2019s ChatGPT, were utilized for grammar refinement and typographical error correction. These tools were employed solely to enhance the clarity and readability of the text, without altering the scientific content or interpretation of the findings. All intellectual and conceptual contributions remain the responsibility of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Use of artificial intelligence"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"265"}}