Changes in superficial temporal artery blood flow and cerebral hemodynamics of moyamoya disease after extracranial-intracranial bypass surgery

Moyamoya disease is characterized by the progressive stenosis and often occlusion of the terminal internal carotid arteries, which leads to ischemic and hemorrhagic injuries. The etiology is unknown and surgical revascularization remains the mainstay treatment. We analyzed various hemodynamic factors in 292 patients with moyamoya disease, representing 496 revascularization procedures, including vessel dimension and intraoperative blood flow, using a perivascular ultrasonic flowprobe. Mean middle cerebral artery (MCA) flow rate was 4.4±0.26 mL/min. After superficial temporal artery (STA)–MCA bypass surgery, flows at the microanastomosis were increased fivefold to a mean of 22.2±0.8 mL/min. The MCA flows were significantly lower in the pediatric (16.2±1.3 mL/min) compared with the adult (23.9±1.0 mL/min; P<0.0001) population. Increased local flow rates were associated with clinical improvement. Permanent postoperative complications were low (<5%), but very high postanastomosis MCA flow was associated with postoperative stroke (31.2±6.8 mL/min; P=0.045), hemorrhage (32.1±10.2 mL/min; P=0.045), and transient neurologic deficits (28.6±5.6 mL/min; P=0.047) compared with controls. Other flow and vessel dimension data are presented to elucidate the hemodynamic changes related to the vasculopathy and subsequent to surgical intervention.

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Arterial Bypass Surgery Using a Spontaneously Formed “Bonnet” Superficial Temporal Artery in a Patient With Symptomatic Common Carotid Artery Occlusion

Operative Neurosurgery ◽

10.1227/01.neu.0000383877.00075.b4 ◽

2010 ◽

Vol 67 (3) ◽

pp. onsE316-onsE317 ◽

Cited By ~ 6

Author(s):

Kenta Aso ◽

Kuniaki Ogasawara ◽

Masakazu Kobayashi ◽

Kenji Yoshida

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Common Carotid Artery ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Arterial Bypass ◽

Arterial Bypass Surgery

Abstract BACKGROUND: Common carotid artery (CCA) occlusive disease may cause hemodynamic cerebral ischemia resulting in the development of ischemic symptoms. The blood flow in the superficial temporal artery (STA) ipsilateral to the occluded CCA is usually poor, which limits its use as a donor artery for extracranial-intracranial arterial bypass surgery. CLINICAL PRESENTATION: Despite antiplatelet therapy, recurrent transient ischemic attacks manifesting as motor aphasia developed in a 72-year-old man. Neuroradiological imaging revealed misery perfusion in the bilateral cerebral hemispheres caused by left CCA occlusion and right internal carotid artery occlusion. Blood flow from the STA contralateral to the occluded CCA perfused the ipsilateral STA over the midline in a retrograde fashion. INTERVENTION: After confirming the direction and the pressure of the blood flow in the spontaneously formed “bonnet” STA, the STA was anastomosed to a cortical artery in the symptomatic frontal lobe so that blood flow in the ipsilateral STA was supplied from the contralateral STA. The procedure was accomplished without difficulty, and no further ischemic symptoms developed after surgery. Postoperative cerebral angiography demonstrated an increase in collateral flow to the anastomosed bonnet STA and perfusion to an entire territory of the upper trunk of the symptomatic middle cerebral artery via the anastomosis. CONCLUSION: This case suggests that arterial bypass surgery can be performed using a spontaneously formed bonnet STA as a donor in a patient with symptomatic CCA occlusion.

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Reversible occlusion of donor vessel caused by mouth opening after superficial temporal artery–middle cerebral artery anastomosis in adult moyamoya patients

Journal of Neurosurgery ◽

10.3171/2014.10.jns141805 ◽

2015 ◽

Vol 123 (3) ◽

pp. 670-675 ◽

Cited By ~ 3

Author(s):

Toshiro Katsuta ◽

Hiroshi Abe ◽

Koichi Miki ◽

Tooru Inoue

Keyword(s):

Blood Flow ◽

Middle Cerebral Artery ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Superficial Temporal Artery ◽

Mouth Opening ◽

Temporal Artery ◽

Muscle Layer ◽

Adult Patients ◽

Bone Window

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

Neurosurgical Focus: Video ◽

10.3171/2021.10.focvid21191 ◽

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

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