Postoperative changes in the superficial temporal artery and the external carotid artery duplex sonography after extra-intracranial bypass surgery in European Moyamoya disease

2012 ◽  
Vol 114 (7) ◽  
pp. 930-934 ◽  
Author(s):  
M. Kraemer ◽  
B. Schuknecht ◽  
A.K. Jetzer ◽  
Y. Yonekawa ◽  
N. Khan
Keyword(s):  
Carotid Artery ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Duplex Sonography ◽  
External Carotid Artery ◽  
External Carotid ◽  
Postoperative Changes

Blood volume flow in the superficial temporal artery assessed by duplex sonography: predicting extracranial-intracranial bypass patency in moyamoya disease

2021 ◽  
pp. 1-8
Author(s):  
Florian Connolly ◽  
Joan Alsolivany ◽  
Marcus Czabanka ◽  
Peter Vajkoczy ◽  
Jose M. Valdueza ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Type A ◽  
Temporal Artery ◽  
Duplex Sonography ◽  
External Carotid Artery ◽  
External Carotid ◽  
Catheter Angiography ◽  
Type B ◽  
Bypass Patency

OBJECTIVE Superficial temporal artery–middle cerebral artery (STA-MCA) bypass surgery is an important therapy for symptomatic moyamoya disease. Its success depends on bypass function, which may be impaired by primary or secondary bypass insufficiency. Catheter angiography is the current gold standard to assess bypass function, whereas the diagnostic value of ultrasonography (US) has not been systematically analyzed so far. METHODS The authors analyzed 50 STA-MCA bypasses in 39 patients (age 45 ± 14 years [mean ± SD]; 26 female, 13 male). Bypass patency was evaluated by catheter angiography, which was performed within 24 hours after US. The collateral circulation through the bypass was classified into 4 types as follows: the bypass supplies more than two-thirds (type A); between one-third and two-thirds (type B); or less than one-third (type C) of the MCA territory; or there is bypass occlusion (type D). The authors assessed the mean blood flow velocity (BFV), the blood volume flow (BVF), and the pulsatility index (PI) in the external carotid artery and STA by duplex sonography. Additionally, they analyzed the flow direction of the MCA by transcranial color-coded sonography. US findings were compared between bypasses with higher (types A and B) and lower (types C and D) capacity. RESULTS Catheter angiography revealed high STA-MCA bypass capacity in 35 cases (type A: n = 22, type B: n = 13), whereas low bypass capacity was noted in the remaining 15 cases (type C: n = 12, type D: n = 3). The BVF values in the STA were 60 ± 28 ml/min (range 4–121 ml/min) in the former and 12 ± 4 ml/min (range 6–18 ml/min) in the latter group (p < 0.0001). Corresponding values of mean BFV and PI were 57 ± 21 cm/sec (range 16–100 cm/sec) versus 22 ± 8 cm/sec (range 10–38 cm/sec) (p < 0.0001) and 0.8 ± 0.2 (range 0.4–1.3) versus 1.4 ± 0.5 (range 0.5–2.4) (p < 0.0001), respectively. Differences in the external carotid artery were less distinct: BVF 217 ± 71 ml/min (range 110–425 ml/min) versus 151 ± 41 ml/min (range 87–229 ml/min) (p = 0.001); mean BFV 47 ± 17 cm/sec (range 24–108 cm/sec) versus 40 ± 7 cm/sec (range 26–50 cm/sec) (p = 0.15); PI 1.5 ± 0.4 (range 1.0–2.5) versus 1.9 ± 0.4 (range 1.2–2.6) (p = 0.009). A retrograde blood flow in the MCA was found in 14 cases (9 in the M1 and M2 segment; 5 in the M2 segment alone), and all of them showed a good bypass function (type A, n = 10; type B, n = 4). The best parameter (cutoff value) to distinguish bypasses with higher capacity from bypasses with lower capacity was a BVF in the STA ≥ 21 ml/min (sensitivity 100%, negative predictive value 100%, specificity 91%, positive predictive value 83%). CONCLUSIONS Duplex sonography is a suitable diagnostic tool to assess STA-MCA bypass function in moyamoya disease. Hemodynamic monitoring of the STA by US provides an excellent predictor of bypass patency.

Side-to-Side Superficial Temporal Artery to Middle Cerebral Artery Bypass Technique: Application of Fourth Generation Bypass in a Case of Adult Moyamoya Disease

2019 ◽  
Vol 18 (5) ◽  
pp. 480-486 ◽  
Author(s):  
Michael J Lang ◽  
Peter Kan ◽  
Jacob F Baranoski ◽  
Michael T Lawton
Keyword(s):  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
External Carotid Artery ◽  
Fourth Generation ◽  
External Carotid ◽  
Flow Properties

Abstract BACKGROUND Moyamoya disease (MMD) is a rare cause of cerebral hemorrhage and ischemia. Spontaneous development of collateral supply from the external carotid artery (ECA) may limit the use of donor arteries used in standard direct bypass techniques. OBJECTIVE To identify the technical feasibility of side-to-side (S-S) superficial temporal artery to middle cerebral artery (STA-MCA) bypass and demonstrate the application of fourth generational bypass techniques in the treatment of MMD. METHODS S-S bypass was performed in order to maintain distal outflow in the donor STA. Fourth generation bypass techniques, including atypical anastomosis construction and intraluminal suturing were utilized. RESULTS The novel S-S STA-MCA bypass was performed, with patent flow in both recipient MCA and endogenous ECA-ICA collaterals supplied by the distal STA. Technical nuances, including proper alignment of donor vessel, tension reduction, and S-S anastomosis construction with intraluminal suturing technique are essential for successful bypass. Unique flow properties of this bypass were identified, resulting in flow augmentation to the recipient territory compared to standard end-to-side (E-S) techniques. CONCLUSION Fourth generational bypass techniques can be successfully applied to MMD, allowing for novel bypass construction. S-S anastomosis can result in potentially beneficial flow properties compared to standard E-S constructions.

Relative contributions of the middle meningeal artery and superficial temporal artery in revascularization surgery for moyamoya syndrome in children: the results of superselective angiography

2010 ◽  
Vol 5 (2) ◽  
pp. 184-189 ◽  
Author(s):  
James A. J. King ◽  
Derek Armstrong ◽  
Shobhan Vachhrajani ◽  
Peter B. Dirks
Keyword(s):  
Carotid Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Neurofibromatosis Type ◽  
Middle Meningeal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Moyamoya Syndrome ◽  
Superselective Angiography ◽  
Sick Children

Object The authors used postoperative superselective angiography to assess the relative contributions of the middle meningeal artery (MMA) and the superficial temporal artery (STA) to revascularization following surgery for moyamoya syndrome in children. Methods Using the neurosurgical database at the Hospital for Sick Children, the authors reviewed the clinical and pre- and postoperative angiographic records obtained in patients with moyamoya syndrome undergoing superselective angiography. Patients were 16 years of age or younger and were undergoing revascularization surgery for moyamoya syndrome during the study period. Lateral internal carotid artery, external carotid artery, STA, and MMA angiograms were analyzed in the late arterial phase to assess the relative contributions of the STA and MMA to overall revascularization as determined by the external carotid artery injection. Results The total moyamoya surgical revascularization experience at the Hospital for Sick Children over a 12-year period (May 1996–December 2008) comprised 33 patients (20 girls and 13 boys) undergoing a total of 50 craniotomies. A decision was made in 2001 to perform superselective angiography postoperatively in patients with moyamoya syndrome. Superselective angiography was identified to have been performed postoperatively in 12 patients and 18 treated hemispheres, and it demonstrated that the MMA contributed more significantly than the STA in 11 (61%) of the 18 hemispheres. Seven patients were Asian, 3 patients had neurofibromatosis Type 1, 1 had Down syndrome, and 2 had no apparent risk factors (1 patient was Asian and had neurofibromatosis Type 1). Stroke had occurred in 58% of patients and transient ischemic attacks in 50% prior to surgery. Within the first 30 days of surgery, there were 2 episodes of stroke (11.7% per surgically treated hemisphere and 18.2% per patient). Seventy-eight percent of hemispheres surgically treated exhibited excellent revascularization (Matsushima Grade A) on follow-up angiography, and there were no strokes documented in any patients more than 1 month after surgery, in a long-term follow-up of mean 4.1 years. Conclusions The contributions of the MMA to revascularization after pial synangiosis for moyamoya syndrome are significant and may frequently exceed the contribution of the STA when surgery is performed with preservation of dural vasculature and dural inversion.

scholarly journals Effectiveness of alternative routes of intra-arterial chemotherapy administration for retinoblastoma: Potential for response and complications

2019 ◽  
Vol 25 (5) ◽  
pp. 556-561
Author(s):  
Coridon Quinn ◽  
Ramachandra Tummala ◽  
Jill Anderson ◽  
Tambra Dahlheimer ◽  
David Nascene ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Middle Meningeal Artery ◽  
Vascular Supply ◽  
External Carotid Artery ◽  
Alternative Methods ◽  
External Carotid ◽  
Chemotherapy Administration ◽  
Selective Catheterization

Objective Intra-arterial chemotherapy (IAC) is now the first line treatment for selected patients with retinoblastoma (Rb). Typically, IAC is infused following the selective catheterization of the ophthalmic artery (OA) on the affected side. However, in some patients, the OA alone may not provide vascular supply to the tumor, whereas in other instances the efficacy of IAC could be compromised due to the presence of prominent collateral vessels from the external carotid artery (ECA). We report our experience with catheterizing vessels other than the OA for IAC treatment for Rb. Methods After institutional review board approval, a retrospective analysis was conducted of electronic medical records and imaging of our Rb population. Results We identified 13 patients who received IAC for Rb treatment. Of these, five patients required alternative methods of chemotherapy delivery other than through the OA, totaling 17 treatments. Two patients needed balloon-assisted occlusion of the ECA, two patients required selective catheterization of the middle meningeal artery, and one patient had no internal carotid artery supply to the choroidal blush, thus the superficial temporal artery provided access for IAC. Total globe salvage rate was 76% and 80% with the alternative route subset. Conclusions Alternatives to the OA may be necessary to deliver IAC for selected cases of Rb. These routes can be safe and effective. However, thorough understanding of the orbital blood supply is essential. Whether these alternative IAC methods result in similar outcomes to OA infusions has not been established.

Aneurysmen der distalen Arteria carotis externa

VASA ◽  
2000 ◽  
Vol 29 (1) ◽  
pp. 87-88 ◽  
Author(s):  
Vassilios G. Papavassiliou ◽  
Liapis ◽  
Kakissis ◽  
Safioleas ◽  
Kaperonis ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Traumatic Aneurysm ◽  
First Case ◽  
Pulsatile Mass ◽  
Posterior Auricular Artery ◽  
The Right

Aneurysms of the distal branches of the external carotid artery are rare and usually traumatic in origin. We present two cases which were treated in our clinic. The first case is about a traumatic aneurysm of the left superficial temporal artery (STA) in a young boy 8 years old. The young patient developed a pulsatile mass above his left eyebrow ten days after a bite by a boy of the same age. The second case is referred in a 36-year old woman with a pulsatile mass behind the right ear, which was an aneurysm of the posterior auricular artery. The treatment was ligation and resection under local anesthesia in the first case and under general anesthesia in the latter. Surgeons’ familiarity with this entity is important for diagnosis and treatment.

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