Strategic tunnelling of superficial temporal artery during bypass surgery for moyamoya disease

2022 ◽  
Author(s):  
Bhanu Jayanand Sudhir ◽  
Arunkumar Karthikayan ◽  
Jamaludeen Mohammed Amjad ◽  
Keelara Gowda Arun
Keyword(s):  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery

scholarly journals Application of FLOW 800 in extracranial-to-intracranial bypass surgery for moyamoya disease

2022 ◽  
Vol 6 (1) ◽  
pp. V16
Keyword(s):  
Cerebral Cortex ◽  
Surgical Treatment ◽  
Middle Cerebral Artery ◽  
Real Time ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Flow 800

The surgical treatment of moyamoya disease is heavily reliant upon a real-time understanding of cerebral hemodynamics. The application of FLOW 800 allows the surgeon to semiquantify the degree of perfusion to the cerebral cortex following extracranial-to-intracranial (EC-IC) bypass surgery. The authors present three illustrative cases demonstrating common intraoperative findings prior to and following anastomosis using FLOW 800. All patients were diagnosed by catheter angiogram with moyamoya disease and noninvasive imaging demonstrating hemispheric hypoperfusion. Superficial temporal artery (STA)–to–middle cerebral artery (MCA or M4) bypasses were performed to augment intracranial perfusion. The patients tolerated the procedures well and were discharged without event in stable neurological condition. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21191

Development of Arteriovenous Fistula After Revascularization Bypass for Moyamoya Disease

2014 ◽  
Vol 11 (1) ◽  
pp. E202-E206 ◽  
Author(s):  
Abdullah H Feroze ◽  
Jacob Kushkuley ◽  
Omar Choudhri ◽  
Jeremy J Heit ◽  
Gary K Steinberg ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Arteriovenous Fistula ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
De Novo ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Fistula Formation

Abstract BACKGROUND AND IMPORTANCE Moyamoya disease is a rare cerebrovascular disorder often treated by direct and indirect revascularization bypass techniques as a result of a typically devastating disease course and poor response to medical therapy. In this report, we describe the formation and subsequent management of a de novo arteriovenous fistula identified in the setting of a patient treated with direct bypass surgery, a previously unreported phenomenon. CLINICAL PRESENTATION A 51-year-old woman presenting with Suzuki stage IV bilateral moyamoya disease underwent bilateral extracranial-to-intracranial superficial temporal artery--to--middle cerebral artery bypass without complication at our institution. At the 6-month follow-up, she demonstrated no evidence of residual neurological deficits or continued symptoms despite documentation of an arteriovenous fistula arising at the site of the right extracranial-to-intracranial bypass on routine follow-up cerebral angiography. CONCLUSION We present the first reported case of de novo arteriovenous fistula formation after superficial temporal artery-to-middle cerebral artery bypass for the treatment of moyamoya disease. Treatment of such iatrogenic arteriovenous fistulae fed by a patent bypass vessel may prove challenging without associated compromise of the bypass, meriting careful evaluation of all potential therapeutic options. The fistula described herein most likely occurred secondary to recanalization of a previously thrombosed vein of Trolard. This case demonstrates the possibility of arteriovenous fistula formation as a potential sequela of revascularization bypass surgery and lends support to the previously described traumatic origin of fistula formation.

Abstract WP414: Ultrasonographic Changes after Indirect Bypass Surgery in Pediatric Patients with Moyamoya Disease

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Shin-Joe Yeh ◽  
Sung-Chun Tang ◽  
Li-Kai Tsai ◽  
Ya-Fang Chen ◽  
Hon-Man Liu ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Pediatric Patients ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Hypoperfusion ◽  
Mean Flow ◽  
Pronounced Increase ◽  
Intracranial Arteries

Background: The marked cerebral hypoperfusion caused by moyamoya disease (MMD) usually manifests as ischemic stroke or transient ischemic attack. The treatment of choice for MMD is extracranial-intracranial bypass surgery; however, the changes of ultrasonographic features following indirect bypass surgery are unknown. This study sought to characterize the ultrasonographic changes that result from indirect bypass surgery in pediatric patients with MMD. Methods: We prospectively recruited 15 pediatric MMD patients who had undergone a total of 19 indirect bypass surgeries (encephaloduroarteriosynangiosis, EDAS) and obtained the relevant clinical and radiological characteristics. Neurovascular ultrasonography of extracranial and intracranial arteries was performed pre-operatively and post-operatively at 1, 3, and 6 months. Results: Among the 15 patients (11 males, 4 females), the mean age was 10.4 ± 4.6 years. Among the extracranial arteries, the superficial temporal artery presented the most pronounced increase in flow velocity and decrease in flow resistance, beginning at 1 month post-op (all p<0.01). Among the large intracranial arteries, a significant increase in mean flow velocity was observed in the anterior cerebral artery since 3 months post-op (p<0.05). Conclusion: Significant hemodynamic changes were observed in pediatric MMD patients after EDAS surgery, as evidenced by periodic ultrasonographic assessment.

scholarly journals Correlation between reduction in microvascular transit time after superficial temporal artery–middle cerebral artery bypass surgery for moyamoya disease and the development of postoperative hyperperfusion syndrome

2018 ◽  
Vol 128 (5) ◽  
pp. 1304-1310 ◽  
Author(s):  
Tao Yang ◽  
Yoshifumi Higashino ◽  
Hiroharu Kataoka ◽  
Eika Hamano ◽  
Daisuke Maruyama ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Transit Time ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Multivariate Logistic Regression Analysis ◽  
Temporal Artery ◽  
Hyperperfusion Syndrome ◽  
Multiple Variables

OBJECTIVEHyperperfusion syndrome (HPS) is a notable complication that causes various neurological symptoms after superficial temporal artery (STA)–middle cerebral artery (MCA) bypass surgery for moyamoya disease (MMD). The authors used intraoperative indocyanine green (ICG) videoangiography to measure the change in microvascular transit time (MVTT) after bypass surgery. An analysis was then conducted to identify the correlation between change in MVTT and presence of postoperative HPS.METHODSThis study included 105 hemispheres of 81 patients with MMD who underwent STA-MCA single bypass surgery between January 2010 and January 2015. Intraoperative ICG videoangiography was performed before and after bypass surgery. The MVTT was calculated from the ICG time intensity curve recorded in the pial arterioles and venules. Multivariate logistic regression analysis was conducted to test the effect of multiple variables, including the change in MVTT after bypass surgery, on postoperative HPS.RESULTSPostoperative HPS developed in 28 (26.7%) of the 105 hemispheres operated on. MVTT was reduced significantly after bypass surgery (prebypass 5.34 ± 2.00 sec vs postbypass 4.12 ± 1.60 sec; p < 0.001). The difference between prebypass and postbypass MVTT values, defined as ΔMVTT, was significantly greater in the HPS group than in the non-HPS group (2.55 ± 2.66 sec vs 0.75 ± 1.78 sec; p < 0.001). Receiver operating characteristic curve analysis revealed that the optimal cutoff point of ΔMVTT was 2.6 seconds (sensitivity 46.4% and specificity 85.7% as a predictor of postoperative HPS). A ΔMVTT > 2.6 seconds was an independent predictor of HPS in multivariate analysis (hazard ratio 4.88, 95% CI 1.76–13.57; p = 0.002).CONCLUSIONSMVTT in patients with MMD was reduced significantly after bypass surgery. Patients with a ΔMVTT > 2.6 seconds tended to develop postoperative HPS. Because ΔMVTT can be easily measured during surgery, it is a useful diagnostic tool for identifying patients at high risk for HPS after STA-MCA bypass surgery for MMD.

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