{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T15:55:27Z","timestamp":1759334127149,"version":"build-2065373602"},"reference-count":8,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Adult moyamoya disease (MMD) is a progressive steno-occlusive cerebrovascular disorder for which surgical revascularization is the primary treatment. The standard direct superficial temporal artery\u2013middle cerebral artery (STA-MCA) bypass uses the frontal and\/or parietal branch of the STA as the donor. However, in some patients, conventional STA-MCA bypass may be suboptimal because of a large mismatch in caliber between the STA branch and the recipient artery, increasing the risk of cerebral hyperperfusion. This study aimed to investigate the impact of a modified STA-MCA bypass on MMD treatment. Methods: We retrospectively reviewed adult cases of MMD at our institution (2012\u20132025) for patients who underwent modified direct STA-MCA bypass using a small side branch of the STA as the donor artery. Surgical techniques and clinical outcomes of these cases were analyzed descriptively. Results: Five cases (five hemispheres in four patients) underwent side-branch STA-MCA bypass. All procedures were completed successfully, with 100% graft patency confirmed by intraoperative indocyanine green angiography, and a mild increase in cerebral blood flow confirmed by postoperative single-photon emission computed tomography. No patients developed postoperative cerebral hyperperfusion syndrome or wound healing complications. Clinically, all patients experienced a stable or improved neurological status, with no reported new ischemic or hemorrhagic events during follow-up. Conclusions: In this small feasibility series, the side-branch STA\u2013MCA bypass was technically feasible and safe, with no cerebral hyperperfusion syndrome observed. Any risk-mitigating effect on hyperperfusion remains theoretical and requires confirmation in comparative studies.<\/jats:p>","DOI":"10.3390\/jcm14196904","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:12:23Z","timestamp":1759223543000},"page":"6904","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of a Modified Superficial Temporal Artery\u2013Middle Cerebral Artery Bypass Using Superficial Temporal Artery Side-Branch Donors in Adult Moyamoya Disease: A Technical Note"],"prefix":"10.3390","volume":"14","author":[{"given":"Shintaro","family":"Arai","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku  142-8555, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Sugiyama","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Koto-Toyosu Hospital, Showa Medical University, 5-1-38 Toyosu, Koto-ku 135-8577, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tohru","family":"Mizutani","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Koto-Toyosu Hospital, Showa Medical University, 5-1-38 Toyosu, Koto-ku 135-8577, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7291-0693","authenticated-orcid":false,"given":"Kenji","family":"Sumi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku  142-8555, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5267-180X","authenticated-orcid":false,"given":"Masaki","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku  142-8555, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3484-9278","authenticated-orcid":false,"given":"Kouzou","family":"Murakami","sequence":"additional","affiliation":[{"name":"Department of Radiology, School of Medicine, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku 142-8555, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3541-0679","authenticated-orcid":false,"given":"Ryo","family":"Irie","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fujigaoka Hospital, Showa Medical University, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Kanagawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7135-2220","authenticated-orcid":false,"given":"Yoichi","family":"Morofuji","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, School of Medicine, Showa Medical University, 1-5-8 Hatanodai, Shinagawa-ku  142-8555, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1001\/archneur.1969.00480090076012","article-title":"Cerebrovascular \u201cmoyamoya\u201d disease. Disease showing abnormal net-like vessels in the base of the brain","volume":"20","author":"Suzuki","year":"1969","journal-title":"Arch. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"165","DOI":"10.2176\/jns-nmc.2021-0382","article-title":"2021 Japanese guidelines for the management of moyamoya disease: Guidelines from the Research Committee on Moyamoya Disease and Japan Stroke Society","volume":"15","author":"Fujimura","year":"2022","journal-title":"Neurol. Med. Chir."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1227\/NEU.0000000000000238","article-title":"Minocycline prevents focal neurologic deterioration due to cerebral hyperperfusion after extracranial-intracranial bypass for moyamoya disease","volume":"74","author":"Fujimura","year":"2014","journal-title":"Neurosurgery"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"994.e1","DOI":"10.1016\/j.wneu.2017.09.005","article-title":"Long-term patency of posterior auricular artery\u2013middle cerebral artery bypass for adult-onset moyamoya disease: Case report and review of literature","volume":"108","author":"Torazawa","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Lu, L., Huang, Y., Han, Y., Li, Y., Wan, X., Chen, J., Zhang, X., Shu, K., Lei, T., and Wang, S. (2023). Clinical effect of a modified superficial temporal artery\u2013middle cerebral artery bypass surgery in moyamoya disease treatment. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1273822"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1093\/ons\/opz268","article-title":"Side-to-side superficial temporal artery\u2013middle cerebral artery bypass technique: Application of fourth-generation bypass in a case of adult moyamoya disease","volume":"18","author":"Lang","year":"2020","journal-title":"Oper. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2610","DOI":"10.1161\/STROKEAHA.112.654723","article-title":"Predictors and clinical features of postoperative hyperperfusion after surgical revascularization for moyamoya disease: A serial single-photon emission CT\/positron emission tomography study","volume":"43","author":"Uchino","year":"2012","journal-title":"Stroke"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1159\/000120172","article-title":"Moyamoya disease in children and its surgical treatment","volume":"11","author":"Matsushima","year":"1984","journal-title":"Pediatr. Neurosurg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6904\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:50:33Z","timestamp":1759225833000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/19\/6904"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,29]]},"references-count":8,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14196904"],"URL":"https:\/\/doi.org\/10.3390\/jcm14196904","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,9,29]]}}}