Computerized tomographic angiography for preoperative assessment of the superficial temporal artery for external carotid artery to internal carotid artery bypass: Case illustration

Abstract We review our recent experience with occlusion of the cervical internal carotid artery (ICA) in 15 patients with symptomatic aneurysms of the cavernous segment. All the patients were women and ranged in age from 38 to 74 years. Ten patients sought treatment initially for ophthalmoplegia, 9 for retro-orbital pain, 8 for facial paresthesia, and 3 for loss of vision. Two patients had symptoms of transient ocular or brain ischemia. The diameter of the aneurysm was greater than 3 cm in 10 patients. Ten patients underwent gradual occlusion of the ICA by Selverstone clamp under anticoagulation and monitoring of neurological status. One patient underwent ligation of a severely stenotic ICA under general anesthesia and electroencephalographic monitoring. Four patients underwent trapping of the aneurysm (after attempts at direct obliteration) under electroencephalographic and cerebral blood flow monitoring. Two patients with incompetent circle of Willis collaterals underwent prophylactic superficial temporal artery to middle cerebral artery bypass surgery prior to ICA occlusion. There was no postoperative clinical change in 9 patients. Ophthalmoplegia improved in 2 patients, and facial pain improved in 3. Three patients developed new extraocular muscle palsies within hours of ICA occlusion; these resolved in all patients by 1 week postoperatively. No change in aneurysm size was documented by serial postoperative computed tomographic or magnetic resonance imaging scans. After a follow-up of 5 to 6 years (range, 6 months-9 years), 11 patients have remained neurologically stable. Two patients experienced delayed transient worsening of visual or facial symptoms. Two patients developed delayed ipsilateral brain ischemia: one patient had a visibly patent superficial temporal artery to middle cerebral artery bypass; the second patient had an occluded A-1 segment that previously had been patent. These results are discussed in light of direct approaches and recent techniques of intervention.

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Simultaneous Left Superficial Temporal Artery−Middle Cerebral Artery Bypass and Encephalodurovenosynangiosis for Progressive Atherosclerosis of the Left Internal Carotid Artery Communicating Segment

World Neurosurgery ◽

10.1016/j.wneu.2020.04.212 ◽

2020 ◽

Vol 139 ◽

pp. 149-150

Author(s):

Turki Elarjani ◽

Faris Alebdi ◽

Abdullah Alobaid

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Internal Carotid ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Left Internal Carotid Artery

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Universal External Carotid Artery to Proximal Middle Cerebral Artery Bypass With Interposed Radial Artery Graft Prior to Approaching Ruptured Blood Blister-Like Aneurysm of the Internal Carotid Artery

Neurologia medico-chirurgica ◽

10.2176/nmc.49.553 ◽

2009 ◽

Vol 49 (11) ◽

pp. 553-558 ◽

Cited By ~ 33

Author(s):

Tatsuya ISHIKAWA ◽

Tatsushi MUTOH ◽

Naoki NAKAYAMA ◽

Hiroshi YASUDA ◽

Mikio NOMURA ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Internal Carotid ◽

Artery Bypass ◽

External Carotid Artery ◽

External Carotid ◽

Radial Artery Graft ◽

Artery Graft ◽

Proximal Middle Cerebral Artery

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Successful Surgical Flow Reduction with Superficial Temporal Artery-Middle Cerebral Artery Bypass for Recurrent Internal Carotid Artery Aneurysm in a Pediatric Case

Surgery for Cerebral Stroke ◽

10.2335/scs.44.385 ◽

2016 ◽

Vol 44 (5) ◽

pp. 385-389

Author(s):

Yoshichika KIKUTA ◽

Akitsugu KAWASHIMA ◽

Tomonori KOBAYASHI ◽

Takayuki FUNATSU ◽

Emi TANINO ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Artery Aneurysm ◽

Temporal Artery ◽

Pediatric Case ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm

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External Carotid Endarterectomy Followed by Superficial Temporal Artery to Middle Cerebral Artery Anastomosis for Internal Carotid Artery Occlusion with Advanced Ipsilateral External Carotid Stenosis

Operative Neurosurgery ◽

10.1227/01.neu.0000326024.93724.16 ◽

2008 ◽

Vol 62 (suppl_5) ◽

pp. ONS395-ONS399 ◽

Cited By ~ 4

Author(s):

Takakazu Kawamata ◽

Yoshikazu Okada ◽

Akitsugu Kawashima ◽

Kohji Yamaguchi ◽

Tomokatsu Hori

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Internal Carotid Artery Occlusion ◽

External Carotid ◽

Cerebrovascular Complications

Abstract Objective: For patients with internal carotid artery occlusion with advanced narrowing of the ipsilateral external carotid artery (ECA), we performed preventive carotid endarterectomy (CEA) for the ECA stenosis before superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis for internal carotid artery occlusion. Methods: Between August 2002 and July 2005, we treated seven patients with such lesions, six men and one woman, ranging in age from 52 to 66 years (median, 60 yr). Before STA-MCA anastomosis, we performed preventive CEA for advanced ECA stenosis (>70%) to ensure sufficient blood flow to the STA. STA-MCA double anastomoses were performed more than 1 month after the CEA. Postoperative cerebrovascular complications and carotid restenosis were investigated. Results: All patients in the present series had an excellent postoperative course without cerebrovascular complications during either the CEA or STA-MCA anastomosis phase. Furthermore, no postoperative carotid restenosis occurred, and all STA-MCA anastomoses were patent during a mean follow-up period of 35.6 months. Conclusion: The present study suggests that surgical management by external CEA followed by STA-MCA anastomosis is safe and effective for patients with internal carotid artery occlusion and advanced stenosis of the ipsilateral ECA.

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