Efficacy of superficial temporal artery–middle cerebral artery anastomosis with routine postoperative cerebral blood flow measurement during the acute stage in childhood moyamoya disease

OBJECT The authors experienced an intriguing phenomenon in 2 adult patients with moyamoya disease. Mouth opening caused reversible occlusion of the donor superficial temporal artery (STA), and the patients exhibited transient cerebral ischemic symptoms. The aim of this study was to assess the incidence of such occlusion and the mechanism of this phenomenon. METHODS Twelve consecutive adult patients with moyamoya disease (15 affected sides) who underwent STA–middle cerebral artery anastomosis were included in this study. Ultrasound examination was performed more than 3 months postoperatively to determine whether mouth opening affected blood flow of the donor STA and led to any ischemic symptoms within 1 minute. Computed tomography angiography was performed during both mouth opening and mouth closing, when blood flow changes of the donor STA were recognized. RESULTS Under wide mouth opening, steno-occlusion of the donor STA occurred in 5 of 15 sides (33.3%). On 1 side (6.7%), complete occlusion induced ischemic symptoms. Steno-occlusion occurred by at least 2 mechanisms: either the stretched temporalis muscle pushed the donor STA against the edge of the bone window, or the redundant donor STA kinked when the muscle was stretched. CONCLUSIONS Even with temporary occlusion of the donor STA, ischemic symptoms seem to rarely occur. However, to avoid the “big bite ischemic phenomenon,” the authors recommend securing a sufficient distance between the donor STA and the edge of the bone window and avoiding a redundant course of the donor STA within the muscle layer.

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Quantitative Evaluation of Focal Cortical Blood Flow during Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery for Patients with Moyamoya Disease

Surgery for Cerebral Stroke ◽

10.2335/scs.43.207 ◽

2015 ◽

Vol 43 (3) ◽

pp. 207-211

Author(s):

Yoshio ARAKI ◽

Kinya YOKOYAMA ◽

Yusuke SAKAMOTO ◽

Kenzo SHIMIZU ◽

Kenji UDA ◽

...

Keyword(s):

Blood Flow ◽

Middle Cerebral Artery ◽

Quantitative Evaluation ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Bypass Surgery ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Cortical Blood Flow

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“Target Bypass”: A Method for Preoperative Targeting of A Recipient Artery in Superficial Temporal Artery-to-Middle Cerebral Artery Anastomoses

Operative Neurosurgery ◽

10.1227/01.neu.0000232775.06672.f4 ◽

2006 ◽

Vol 59 (suppl_4) ◽

pp. ONS-320-ONS-327 ◽

Cited By ~ 4

Author(s):

Ken-ichiro Kikuta ◽

Yasushi Takagi ◽

Yasutaka Fushimi ◽

Kouichi Ishizu ◽

Tsutomu Okada ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Magnetic Resonance ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Regional Cerebral Blood Flow ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Regional Cerebral Blood ◽

Recipient Artery

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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