Moyamoya disease is a cerebrovascular disease of unknown etiology, which leads to a narrowing or occlusion of both internal carotid arteries in the presence of an abnormal hemangiomatosis vascular network at the base of the brain. The efficacy of encephalo-myosynangiosis (EMS) using muscle free flap was evaluated for the treatment of ischemic cerebrovascular disease in adult patients. A 36-year-old man presented right side motor weakness and mental change. The neurological examination and image work up revealed intracranial hemorrhage with moyamoya disease. In this case, latissimus dorsi muscular free flap were used for increased perfusion of the ischemic cortical region by indirect anastomosis. Cerebral blood flow study disclosed postoperative improvement of perfusion reserve capacity in all sides. EMS using muscle free flap is a possible procedure in selected patients with impaired cerebral perfusion reserve capacity due to multiple stenosis or occlusion of cerebral arteries including moyamoya disease.
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