Cinematic Rendering of Extracranial to Intracranial Arterial Bypass.

A 51-year-old man initially presented with right-side weakness. Magnetic resonance imaging showed watershed and left middle cerebral artery (MCA) infarcts as well as a high-grade stenosis of the distal internal carotid artery and the proximal MCA with enlarged lenticulostriate perforators. The diagnosis of moyamoya disease was confirmed by cerebral digital subtraction angiography. Exhausted neurovascular reserve capacity in the Diamox challenge test was confirmed. After interdisciplinary discussion, the decision was made to offer extracranial–intracranial arterial bypass surgery to the patient. Surgery was performed under neuronavigation and augmented reality conditions with end-to-side anastomosis between the frontal branch of the superficial temporal artery with an M4 branch of the left MCA.1 Postoperative clinical examination was unremarkable. Immediate postoperative imaging showed a patent arterial bypass (Fig. 1) and improvement of the parenchymal perfusion. Radiological follow-up 5 years after surgery show no new silent infarcts, an increasing stenosis of the internal carotid artery/MCA, and a further development of the arterial bypass. Both authors contributed to the conception and design of the study; the acquisition and analysis of data; and drafting the text and preparing the figure. Nothing to report. VIDEO S1: Cinematic rendering of the extracranial–intracranial bypass. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.