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.

Ruptured De Novo Aneurysm Arising at a Site Remote From the Anastomosis 14 Years After Superficial Temporal Artery-Middle Cerebral Artery Bypass

Neurosurgery ◽  
2012 ◽  
Vol 71 (4) ◽  
pp. E905-E909 ◽  
Author(s):  
Takachika Aoki ◽  
Munetake Yoshitomi ◽  
Masafumi Yamamoto ◽  
Masaru Hirohata ◽  
Motohiro Morioka
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
De Novo ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Long Term Outcome ◽  
De Novo Aneurysm ◽  
Hemodynamic Force ◽  
A Site

Abstract BACKGROUND AND IMPORTANCE: The long-term outcome of superficial temporal artery (STA)–middle cerebral artery (MCA) bypass is unclear. We report a very rare case of a de novo aneurysm after bypass surgery. CLINICAL PRESENTATION: A 57-year-old woman who underwent STA-MCA bypass and internal carotid artery aneurysm treatment 14 years earlier developed a subarachnoid hemorrhage and a temporal lobe hematoma on the same side as the anastomosis. Angiography showed excellent patency of the STA bypass and a ruptured de novo saccular aneurysm at a site remote from the anastomosis. Neck clipping and hematoma evacuation were performed on the second day, and postoperative angiography showed complete aneurysmal clipping. The aneurysm was considered to be caused by hemodynamic stress because it was remote from the anastomosis and had developed after a prolonged interval of 14 years; furthermore, the aneurysm projected because of the hemodynamic force of the STA perfusion. CONCLUSION: This is the first reported case of a de novo MCA aneurysm that developed at a site remote from STA-MCA anastomosis because of hemodynamic force. Therefore, long-term control of blood pressure and repeated imaging examination should be performed to confirm patency and to identify aneurysm formation after STA-MCA bypass.

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.

De Novo Aneurysm Formation on Middle Cerebral Artery Branches Adjacent to the Anastomotic Site of Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery in Two Patients: Technical Case Report

2007 ◽  
Vol 61 (suppl_5) ◽  
pp. ONSE297-ONSE298 ◽  
Author(s):  
Tetsu Kurokawa ◽  
Kei Harada ◽  
Hideyuki Ishihara ◽  
Hirosuke Fujisawa ◽  
Shoichi Kato ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Bypass Surgery ◽  
Internal Carotid ◽  
De Novo ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Aneurysm Formation ◽  
De Novo Aneurysm

Abstract Objective: Aneurysm formation is a complication of superficial temporal arterymiddle cerebral artery bypass surgery occurring as pseudoaneurysms caused by technical failure, but also as true aneurysms discovered after long-term follow-up. Clinical Presentation: A 53-year-old woman presented with a left internal carotid artery cavernous aneurysm manifesting as double vision. Superficial temporal artery-middle cerebral artery bypass, internal trapping of the internal carotid artery, and embolization were performed. Three years later, angiography disclosed a distal middle cerebral artery aneurysm. A 70-year-old man who had undergone right superficial temporal artery-middle cerebral artery bypass after internal carotid artery occlusion died of subarachnoid hemorrhage from a ruptured anterior spinal artery aneurysm 21 years later. Angiography and postmortem examination revealed de novo aneurysm formation on a middle cerebral artery branch adjoining the anastomotic site. Both patients had hypertension and multiplicity of aneurysms. Interpretation: Both cases were de novo true aneurysms caused by hemodynamic stress because of saccular to fusiform shape, location extending to the middle cerebral artery, high perfusion pressure, projection along the hemodynamic stress, and presence of common risk factors. Conclusion: Bypass surgery is increasingly performed in patients with complicated aneurysms if sacrifice or temporary occlusion of any major vessel is required. Therefore, de novo aneurysm formation may not be rare in patients with risk factors such as hypertension or multiple aneurysms. Extended follow-up examination is required in such patients.

Superficial Temporal Artery to Proximal Middle Cerebral Artery Anastomosis: Clinical and Angiographic Long Term Results

Neurosurgery ◽  
1986 ◽  
Vol 19 (6) ◽  
pp. 992-997 ◽  
Author(s):  
Massimo Collice ◽  
Orazio Arena ◽  
Romero A. Fontana
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Good Alternative ◽  
Neurological Complications ◽  
Long Term Results ◽  
Cortical Surface ◽  
First Choice

Abstract Anastomosis of the superficial temporal artery (STA) with a proximal segment of the middle cerebral artery (MCA) has been proposed as a new cerebral revascularization technique alternative to the conventional bypass on the cortical surface. We introduced this procedure in our surgical practice in 1982 for patients with internal carotid artery (ICA) aneurysms not suitable for direct repair in whom occlusion of the ICA is considered necessary. One patient died because a conventional STA-MCA bypass did not prevent a major stroke caused by a therapeutic ICA occlusion. We are reporting our surgical technique and the immediate and long term clinical and angiographic results in five cases operated on during the period June 19, 1982, through January 19, 1983. The early and late patency rates were good. No neurological complications were observed after the bypass procedure or during a 3-year follow-up period. In our opinion, the use of proximal segments of the MCA as recipient arteries for supratentorial revascularization is a good alternative to the use of cortical surface arteries and, in selected cases, could be the first choice technique.

scholarly journals Bonnet Bypass for Left Superficial Temporal Artery Bifurcation to Right Middle Cerebral Artery: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E201-E202 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Superficial Temporal Artery ◽  
Video Recording ◽  
Temporal Artery ◽  
Interposition Graft ◽  
Institutional Review ◽  
Bypass Patency ◽  
Pass Through

Abstract A bonnet bypass is a long interposition graft bypass used for extracranial to intracranial revascularization, which is useful in patients who do not have a suitable ipsilateral donor or in whom the ipsilateral donor must be sacrificed. This interposition graft is commonly the radial artery or saphenous vein. The only practical difference in this technique for revascularization is that an interposition graft must pass through the subgaleal space to the contralateral scalp to allow for reimplantation at the desired contralateral point of anastomosis. This patient underwent a bonnet bypass for revascularization of the middle cerebral artery (MCA) perfusion territory utilizing the contralateral superficial temporal artery (STA). A saphenous vein was used as the interposition graft, which was anastomosed to an M2 segment bifurcation. The graft was then temporarily occluded and passed within a calvarial trough to the contralateral frontoparietal region. The graft was then anastomosed to the contralateral STA at a bifurcation to accommodate the graft size mismatch. The patient tolerated the bypass procedure well and demonstrated bypass patency on postoperative angiographic imaging. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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