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[BACKGROUND] Moyamoya disease is characterized by the progressive stenosis and often occlusion of the terminal internal carotid arteries, which leads to ischemic and hemorrhagic injuries.The cerebral revascularization is the only effective way to treat the disease, but there have been limited reports on hemodynamic changes intra and post bypass surgery.[OBJECTION] To evaluate the therapeutic effect of superficial temporal artery-middle cerebral artery bypass combined with an indirect revascularization procedure, encephalo-duro-myo-synangiosis, in the treatment of moyamoya disease.[METHODS] The evaluations were measured by intra-operative Doppler ultrasound, ICG fluorescence angiography, and intra-operative MRI, then by CTA/DSA and CTP at 1 week and 6 months post the operation.All clinical and radiological data was retrospective reviewed.[RESULTS] From October 2005 to February 2012,we performed this combined revascularization procedure in 390 patients with different types and stages of moyamoya disease.The mean follow-up time was 72.5 months.The indirect procedure (encephalo-duro-myo-synangiosis) resulted in extensive anastomoses of the deep temporal artery and the middle meningeal artery with the cortical arteries, as well the sphenopalatine artery with the cortical arteries in 35 cases.The superficial temporal artery, deep temporal artery, and the middle meningeal artery thicken significantly in the by 74.3%, 1.3% and 115.7%, respectively.The relative cerebral blood flow increased significantly within one week after the operation.At 6 months post the operation, the relative cerebral blood flow further increased by 15.5% as the gradual formation of the anastomoses as a result of indirect revascularization.Transient ischemic attack was effectively reduced or totally arrested.The neurological deficits significantly improved in 37 patients, with the National Institutes of Health Stroke Scale scores lowered by 2-8.There was no rehemorrhage in hemorrhagic moyamoya disease patients.[Conclusion] This study showed that the superficial temporal artery-middle cerebral artery bypass combined with encephalo-duro-myo-synangiosis can achieve good therapeutic effect in the treatment of moyamoya disease.