Measurements of regional cerebral blood flow in patients following superficial temporal artery-middle cerebral artery anastomosis

Abstract OBJECTIVE: To introduce a method for preoperative targeting of a proper recipient artery in superficial temporal artery-to-middle cerebral artery anastomosis. METHODS: Six operations for superficial temporal artery-to-middle cerebral artery anastomosis in four patients with moyamoya disease or moyamoya-like disease and two operations in two patients with atherosclerotic cerebrovascular occlusive disease accompanied by coronary artery stenosis were performed using our method. Before surgery, a 3-Tesla magnetic resonance imaging study was performed with axial T1-weighted three-dimensional magnetization-prepared rapid acquisition gradient-echo sequences and three-dimensional time-of-flight magnetic resonance angiography. Data on quantitative regional cerebral blood flow were obtained by iodine-123-labeled N-isopropyl-iodoamphetamine single-photon emission computed tomography or positron emission computed tomography. The magnetic resonance angiography and regional cerebral blood flow data sets were registered with the magnetization-prepared rapid acquisition gradient-echo data set by means of the coregistration function of the SPM2 software. We examined the arteries located on or near the cortex where the regional cerebral blood flow had significantly decreased and used the coregistered data set and MRIcro software to select the cortical artery with the largest diameter as the target recipient artery. At the surgery, the data sets were applied to the neuronavigation system and the actual site of the target was confirmed in the operation before scalp incision. The superficial temporal artery was anastomosed with the target through a small craniotomy. RESULTS: Successful bypass surgery to the target was confirmed in all cases. @@CONCLUSION:@@ The “target bypass” method might be effective for cases with moya-moya disease or for cases requiring surgery through a small craniotomy.

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Regional cerebral blood flow and oxygen utilization in superficial temporal-middle cerebral artery anastomosis patients

Journal of Neurosurgery ◽

10.3171/jns.1979.50.6.0733 ◽

1979 ◽

Vol 50 (6) ◽

pp. 733-741 ◽

Cited By ~ 53

Author(s):

Robert L. Grubb ◽

Robert A. Ratcheson ◽

Marcus E. Raichle ◽

Arthur B. Kliefoth ◽

Mokhtar H. Gado

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Regional Cerebral Blood Flow ◽

Superficial Temporal Artery ◽

Regional Cerebral Blood ◽

Oxygen Utilization ◽

Cerebrovascular Lesions ◽

Before And After

✓ Regional cerebral blood flow (rCBF) and regional cerebral oxygen utilization (rCMRO2) were measured before and after surgery in nine patients undergoing a superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis to bypass cerebrovascular lesions not amenable to extracranial operative procedures. The objective of these studies was to determine whether measurements of this type could provide objective criteria for surgery as well as assess the effect of surgery. The preliminary data, although limited, suggest that measurements of regional cerebral hemodynamics and metabolism in these patients before and after surgery provide valuable data upon which to develop criteria and assess results. For example, 1) a significant depression of rCBF and rCMRO2 in patients in whom a major cerebral infarction has not occurred, or 2) relative preservation of rCMRO2 despite depressed rCBF seem to be favorable indications for establishing a functioning STA-MCA anastomosis. In such patients, STA-MCA anastomosis can be followed by a return of rCBF and rCMRO2 to virtually normal levels. Relatively normal rCBF and rCMRO2 in the presence of an occluded internal carotid artery in asymptomatic patients indicates satisfactory collateral circulation and is probably a contraindication to surgery.

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Regional cerebral blood flow studies following superficial temporal-middle cerebral artery anastomosis

Journal of Neurosurgery ◽

10.3171/jns.1975.43.6.0706 ◽

1975 ◽

Vol 43 (6) ◽

pp. 706-716 ◽

Cited By ~ 40

Author(s):

M. Peter Heilbrun ◽

O. Howard Reichman ◽

Robert E. Anderson ◽

Theodore S. Roberts

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Regional Cerebral Blood Flow ◽

Internal Carotid ◽

Superficial Temporal Artery ◽

Regional Cerebral Blood ◽

Content Type ◽

Significant Difference

✓ Regional cerebral blood flow (rCBF) studies were performed during the postoperative period on 16 patients with internal carotid occlusions and inaccessible stenoses, and middle cerebral artery occlusion and stenoses, who underwent superficial temporal artery-middle cerebral artery (STA-MCA) anastomoses. The intra-arterial xenon method with selective application of the xenon bolus through the internal carotid and the newly established superficial temporal channel has allowed comparison of the flow provided by the pathological input with flow through the new input. The results show that initial rCBF (rCBF1) was globally reduced in all patients to a mean of 28.4 ± 11.9 ml/100 gm/min at a mean pCO2 of 29.6 ± 9.55 mm Hg. Patients with transient ischemic attacks (TIA) and minor strokes with minimal residua (RIND) had a mean rCBF1 of 30.4 ± 11.6 ml/100 gm/min at a mean pCO2 of 30 ± 10 mm Hg, while patients with completed strokes had a mean rCBF1 of 25.0 ± 12.4 ml/100 gm/min at a mean pCO2 of 29.1 ± 8.8 mm Hg. There was no significant difference between these two groups. This finding suggests that in this small group of patients with TIA's and RIND's, the cause of the stroke is probably related more to decreased perfusion than embolus, and may explain why these patients' symptoms improve after STA-MCA anastomosis. The results of this study suggest that in addition to an inaccessible lesion, global or focal decreased rCBF is a necessary criterion in the definition of indications for intracranial revascularization procedures.

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