A method for cerebral revascularization using latissimus dorsi muscle free flap transfer is described. Latissimus dorsi muscle is harvested with thoracodorsal vessels after completion of craniotomy and exposure of superficial temporal vessels. The size of muscle belly which is harvested is dependent on the area where the revascularization is necessary. Microvascular anastomoses of superficial temporal vessels and thoracodorsal vessels are performed in end-to-end fashion. A 31-year-old male patient with moyamoya syndrome was treated by this method. Postoperative angiography demonstrated successful revascularization in the affected hemisphere, with improved perfusion reserve capacity shown by cerebral blood flow study. This type of encephalo-myo-synangiosis (with free muscle flap) is a possible method when vascular reconstruction of an extensive ischemic area which involves anterior and posterior cerebral artery territories is needed in a patient with moyamoya disease or other similar ischemic conditions.