Superficial Temporal Artery Extended Interposition Graft to Anterior Cerebral Artery Bypass for the Treatment of a Large Fusiform Distal Anterior Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Bhanu Jayanand Sudhir ◽  
Sanjay Honavalli Murali ◽  
Mohamed Amjad Jamaluddin ◽  
Easwer Hariharan Venkat
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Uneventful Recovery ◽  
Interposition Graft ◽  
Marginal Artery ◽  
Fisher Grade ◽  
Distal Anterior Cerebral Artery

Abstract Fusiform aneurysms of the distal anterior cerebral artery (DACA) are infrequent. Clip reconstruction and sequential progressive clipping have been described in the management of giant thrombosed DACA aneurysms.1,2 Customized revascularization with bypass, side-to-side anastomosis, and trapping of the aneurysmal segment have also been performed for treating DACA aneurysms.3-12 We present a 2-dimensional operative video of superficial temporal artery (STA) to distal anterior cerebral artery bypass, followed by trapping of the aneurysm-bearing segment. A 57-yr-old lady presented with a large ruptured subcallosal fusiform DACA aneurysm (WFNS grade 1, Fisher grade 1). Angiography revealed a 1.3 × 0.9 cm fusiform aneurysm in the DACA.  Informed consent was secured from the patient and her family for the surgery and permission was obtained for the publication of the patient's image/surgical video. The frontal and parietal branches of the STA were dissected. The parietal branch was explanted and used as a free interposition graft between the frontal branch (end-to-end anastomosis) and calloso-marginal artery (end-to-side anastomosis). After confirming blood flow through the bypass using Doppler, the aneurysm was trapped and excised.  The patient had an uneventful recovery. Her postoperative computed tomography (CT) head revealed no evidence of neurological insult. The patency of the bypass conduit and the complete removal of the aneurysm were confirmed using a digital subtraction angiogram. Histopathological examination revealed an eccentric atheromatous plaque with a lipid core. There was no evidence of intraplaque hemorrhage. This extended STA graft utilizing the frontal and parietal branches of the STA, and its implantation into the distal ACA, offers a novel bypass strategy for tackling fusiform aneurysms of the DACA. Anastomosis to the calloso-marginal artery ensured perfusion of the ACA territory through the pericallosal artery during temporary occlusion.

Anastomosis of the superficial temporal artery to the distal anterior cerebral artery with interposed cephalic vein graft

1983 ◽  
Vol 58 (3) ◽  
pp. 425-429 ◽  
Author(s):  
Ryoji Ishii ◽  
Tetsuo Koike ◽  
Shigekazu Takeuchi ◽  
Shigeaki Ohsugi ◽  
Ryuichi Tanaka ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Vein Graft ◽  
Anterior Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cephalic Vein ◽  
Revascularization Procedure ◽  
Content Type ◽  
Distal Anterior Cerebral Artery

✓ A newly modified cerebral revascularization procedure for ischemia in the territory of the anterior cerebral artery in moyamoya disease is reported. The approach involves interposition of a cephalic vein graft between the superficial temporal artery and the distal anterior cerebral artery (callosomarginal artery) in combination with bilateral routine superficial temporal artery to middle cerebral artery anastomosis. The surgical technique and the possible role of this procedure are discussed.

LARGE DISTAL ANTERIOR CEREBRAL ARTERY ANEURYSM TREATED WITH RESECTION AND INTERPOSITION GRAFT

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. E1008-E1009 ◽  
Author(s):  
Mikhail Gelfenbeyn ◽  
Sabareesh K. Natarajan ◽  
Laligam N. Sekhar
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Treatment Options ◽  
Superficial Temporal Artery ◽  
Surgical Techniques ◽  
Artery Aneurysm ◽  
Arterial Graft ◽  
Aneurysm Neck ◽  
Interposition Graft ◽  
Distal Anterior Cerebral Artery

Abstract OBJECTIVE Distal anterior cerebral artery (DACA) aneurysms are rare, representing only 2% to 6.7% of all intracranial aneurysms. Most of them are small. Large and giant aneurysms are even rarer in this location. Only 26 giant pericallosal (PC) aneurysms have been reported thus far. Various surgical techniques have been used to treat these aneurysms, including direct aneurysm neck clipping, aneurysm trapping, proximal occlusion of the anterior cerebral artery, or a combination of clipping with coiling or a bypass procedure. The report presents an unusual case of a complex DACA aneurysm managed by resection and interposition arterial graft. CLINICAL PRESENTATION A 69-year-old woman presented with acute onset of a severe headache. A digital subtraction angiogram showed a partially thrombosed, complex broad-necked A2–A3 junction aneurysm involving the origin of PC and callosomarginal vessels with a probability of a dissection of the DACA. The left PC artery was significantly narrowed. Because of the complex neck and involvement of the origin of PC and callosomarginal arteries, endovascular treatment was not possible, and microsurgical treatment was planned. TECHNIQUE A large, partially thrombosed, and fusiform anterior cerebral artery A2–A3 aneurysm, with evidence of previous bleeding, was found and treated with resection and a short interposition graft using a segment of the superficial temporal artery. CONCLUSION Surgical treatment of a large DACA aneurysm may be difficult due to a complex neck and the involvement of the branch vessels. Resection and interposition grafting and A3–A3 or A4–A4 anastomoses are treatment options for such patients.

scholarly journals Revascularization of the anterior cerebral artery by Y-shaped superficial temporal artery interposition graft for the treatment of a de novo aneurysm arising at the site of A3-A3 bypass: technical case report

2018 ◽  
Vol 129 (5) ◽  
pp. 1120-1124 ◽  
Author(s):  
Hidenori Endo ◽  
Shin-ichiro Sugiyama ◽  
Toshiki Endo ◽  
Miki Fujimura ◽  
Hiroaki Shimizu ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
De Novo ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Front Wall ◽  
Interposition Graft ◽  
Anastomosis Site ◽  
De Novo Aneurysm

The most frequently used option to reconstruct the anterior cerebral artery (ACA) is an ACA-ACA side-to-side anastomosis. The long-term outcome and complications of this technique are unclear. The authors report a case of a de novo aneurysm arising at the site of A3-A3 anastomosis. A 53-year-old woman underwent A3-A3 side-to-side anastomosis for the treatment of a ruptured right A2 dissecting aneurysm. At 44 months after surgery, a de novo aneurysm developed at the site of anastomosis. The aneurysm developed in the front wall of the anastomosis site, and projected to the anterosuperior direction. A computational fluid dynamics (CFD) study showed the localized region with high wall shear stress coincident with the pulsation in the front wall of the anastomosis site, where the aneurysm developed. A Y-shaped superficial temporal artery (STA) interposition graft was used successfully to reconstruct both ACAs, and then the aneurysm was trapped. To the authors’ knowledge, this is the first case of a de novo aneurysm that developed at the site of an ACA-ACA side-to-side anastomosis. A CFD study showed that hemodynamic stress might be an underlying cause of the aneurysm formation. A Y-shaped STA interposition graft is a useful option to treat this aneurysm. Long-term follow-up is necessary to detect this rare complication after ACA-ACA anastomosis.

A 1-Donor 2-Recipient Superficial Temporal Artery-Middle Cerebral Artery Bypass for Moyamoya Syndrome: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Nickalus R Khan ◽  
Jacques J Morcos
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Surgical Anatomy ◽  
Large Area ◽  
Ischemic Disease ◽  
Near Occlusion ◽  
Direct Bypass

Abstract We present the case of a 34-yr-old male who suffered repeated ischemic events resulting in right-sided weakness. He was found to have left M1 segment near occlusion on angiography with a large area of uncompensated hypoperfusion. The patient underwent a direct superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Direct bypass in the acute setting of ischemia has been previously described.1-5 Moyamoya ischemic disease can be treated with either direct or indirect surgical revascularization. There have been several techniques developed for direct bypasses in moyamoya ischemic disease. These include the standard 1-donor 1-recipient (1D1R) end-to-side (ES) bypass, the “double-barrel” 2-donor 2-recipient (2D2R) ES bypass, and the more recently developed 1-donor 2-recipient (1D2R)6,7 utilizing both an ES and a side-to-side (SS) bypass with a 1-donor vessel. The case presentation, surgical anatomy, decision-making, operative nuances, and postoperative course and outcome are reviewed. The patient gave verbal consent for participating in the procedure and surgical video.

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