Hello Folks,
My younger brother who is 18 years old, has just been diagonised MMD. He needs revascularization procedure on the left side while the right side does not need any surgical intervension.
His Neuro surgeon has advised to perform a Direct STA-MCA Bypass combined with an Indirect EDAS.
While going through various threads on the forum, It seems like mostly either of the procedure is adopted and not a combination of both.
Hence wanted to undertstand, if a combination of both Direct and Indirect Bypass would be a better option as compared to Just any one of the procedure and if there may be any particular risk factor involved ?
His MRI indicate that he has a good sized left parietal branch  and actually has two frontal branches of the left superficial temporal artery.
Any advise/ insight on the same would be highly appreciated as.
Thanking you in advance.
Tabz.

My neurosurgeon did this as well.  The way it was explained to me is that it could  extra blood flow, the indirect will (or should) eventually grow more vessels; whereas the direct (obviously) creates immediate benefit.   In my case they had the two good branches of the donor right temporal artery.  As far as I know there's no problem with doing it.  I suspect the decision is driven by having a good size Y branch of the temporal artery.  I just consider the indirect as "icing on the cake".

Thnks much Mr JRL..Appreciate it..