scholarly journals Successful shrinkage of anterior communicating artery aneurysm after ACA–ACA bypass with interposed occipital artery graft in pediatric moyamoya disease: illustrative case

2021 ◽  
Vol 2 (17) ◽  
Author(s):  
Kota Nakajima ◽  
Takeshi Funaki ◽  
Masakazu Okawa ◽  
Kazumichi Yoshida ◽  
Susumu Miyamoto
Keyword(s):  
Moyamoya Disease ◽  
Therapeutic Option ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Anterior Communicating Artery ◽  
Occipital Artery ◽  
Illustrative Case ◽  
Artery Graft ◽  
Clinical Scenarios ◽  
Good Patency

BACKGROUND Selecting therapeutic options for moyamoya disease (MMD)-associated anterior communicating artery (ACoA) aneurysm, a rare pathology in children, is challenging because its natural course remains unclear. OBSERVATIONS A 4-year-old boy exhibiting transient ischemic attacks was diagnosed with unilateral MMD accompanied by an unruptured ACoA aneurysm. Although superficial temporal artery to middle cerebral artery anastomosis eliminated his symptoms, the aneurysm continued to grow after surgery. Since a previous craniotomy and narrow endovascular access at the ACoA precluded both aneurysmal clipping and coil embolization, the patient underwent a surgical anastomosis incorporating an occipital artery graft between the bilateral cortical anterior cerebral arteries (ACAs). This was intended to augment blood flow in the ipsilateral ACA territory and to reduce the hemodynamic burden on the ACoA complex. The postoperative course was uneventful, and radiological images obtained 12 months after surgery revealed good patency of the bypass and marked shrinkage of the aneurysm in spite of the intact contralateral internal carotid artery. LESSONS Various clinical scenarios should be assessed carefully with regard to this pathology. Bypass surgery aimed at reducing flow to the aneurysm might be an alternative therapeutic option when neither coiling nor clipping is feasible.

Direct double bypass using the posterior auricular artery as initial surgery for moyamoya disease: technical note

2020 ◽  
Vol 133 (4) ◽  
pp. 1168-1171
Author(s):  
Hiroyuki Kurihara ◽  
Koji Yamaguchi ◽  
Tatsuya Ishikawa ◽  
Takayuki Funatsu ◽  
Go Matsuoka ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Occipital Artery ◽  
Initial Surgery ◽  
Posterior Auricular Artery ◽  
Donor Artery ◽  
Good Patency ◽  
Direct Bypass

Surgical treatments for moyamoya disease (MMD) include direct revascularization procedures with proven efficacy, for example, superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, STA to anterior cerebral artery bypass, occipital artery (OA) to MCA bypass, or OA to posterior cerebral artery bypass. In cases with poor development of the parietal branch of the STA, the posterior auricular artery (PAA) is often developed and can be used as the bypass donor artery. In this report, the authors describe double direct bypass performed using only the PAA as the donor in the initial surgery for MMD.In the authors’ institution, MMD is routinely treated with an STA-MCA double bypass. Some patients, however, have poor STA development, and in these cases the PAA is used as the donor artery. The authors report the use of the PAA in the treatment of 4 MMD patients at their institution from 2013 to 2016. In all 4 cases, a double direct bypass was performed, with transposition of the PAA as the donor artery. Good patency was confirmed in all cases via intraoperative indocyanine green angiography and postoperative MRA or cerebral angiography. The mean blood flow measurement during surgery was 58 ml/min. No patients suffered a stroke after revascularization surgery.

Revascularization of the Anterior Cerebral Artery with an A3–A3 Anastomosis and a Superficial Temporal Artery Bypass Using an A3-Radial Artery Graft to Trap a Giant Anterior Communicating Artery Aneurysm: Technical Case Report

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. E207-E207 ◽  
Author(s):  
Tomohiro Inoue ◽  
Kazuo Tsutsumi ◽  
Hiroyasu Ohno ◽  
Munehisa Shinozaki
Keyword(s):  
Radial Artery ◽  
Anterior Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Anterior Communicating Artery ◽  
Radial Artery Graft ◽  
Anterior Communicating Artery Aneurysm ◽  
Artery Graft

Abstract OBJECTIVE AND IMPORTANCE: How to manage the distal anterior cerebral artery (ACA) circulation in the treatment of a giant anterior communicating artery aneurysm or a giant azygous A2 aneurysm is still controversial. CLINICAL PRESENTATION: We are reporting the case of a 70-year-old man who presented with an evolving giant thrombosed anterior communicating artery aneurysm. INTERVENTION: He was successfully treated by trapping the aneurysm in conjunction with an A3–A3 side-to-side anastomosis and a superficial temporal artery bypass using an A3-radial artery graft. The postoperative angiography showed an excellent filling of all the bilateral distal ACA area through the bypass. CONCLUSION: In cases in which direct clipping to preserve distal ACA flow is quite difficult, the bilateral ACA revascularization described here should be considered as another possibility.

The Y-shaped double-barrel bypass in the treatment of large and giant anterior communicating artery aneurysms

2013 ◽  
Vol 118 (2) ◽  
pp. 444-450 ◽  
Author(s):  
Julius Dengler ◽  
Naoki Kato ◽  
Peter Vajkoczy
Keyword(s):  
Radial Artery ◽  
Therapeutic Option ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Anterior Communicating Artery ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Aneurysm Occlusion ◽  
Partial Thrombosis

Large and giant anterior communicating artery (ACoA) aneurysms usually show partial thrombosis and incorporate both the A1 and A2 segments and crucial perforating vessels. Therefore, direct clip placement or endovascular strategies often fail, leaving cerebral bypass surgery as a relevant therapeutic option. The authors present 3 cases in which a giant or large ACoA aneurysm was successfully occluded using a new technique that applies a double-barrel radial artery bypass. A radial artery graft is modified into a Y-shaped double-barrel conduit. After both pterional and parasagittal craniotomies are carried out, the graft is tunneled between both sites and anastomosed in an end-to-side fashion proximally to either a superficial temporal artery (STA) or M2 branch and distally to bilateral A3 branches. Aneurysm occlusion is then conducted through the pterional or parasagittal craniotomy. In one case, a 42-year-old patient in whom an endovascular approach had failed, the authors performed an STA-A3-A3 bypass and proximal aneurysm occlusion. In two others, a 49-year-old man in whom coiling had failed and a 56-year-old man in whom a giant ACoA aneurysm was partially thrombosed, the authors performed an M2-A3-A3 double-barrel bypass followed by either proximal or distal aneurysm occlusion. Complete aneurysm occlusion with excellent bypass perfusion was documented in the first two cases. In the third case, the authors observed good bypass perfusion with persistent antegrade aneurysm filling, and thus endovascular coil embolization was added to completely occlude the aneurysm. The Y-shaped double-barrel bypass using a radial artery graft allows for safe and effective occlusion of large and giant ACoA aneurysms that cannot be treated by direct clip application.

scholarly journals Treatment of middle cerebral artery aneurysm associated with Moyamoya disease: literature review

2021 ◽  
Author(s):  
Luciano Bambini Manzato ◽  
José Ricardo Vanzin ◽  
Octávio Ruschel Karam ◽  
Victor Emanuel Angeliero ◽  
Artur Eduardo Martio ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Pediatric Patient ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Mesh Terms ◽  
Indirect Revascularization ◽  
Cerebral Artery Aneurysm

Background:Moyamoya disease (MMD) is a steno-occlusive cerebral angiopathy. The incidence of intracranial aneurysms (IA) associated with MMD is high (3.4-14.8%) when compared to the general population (1-3%). IA in the middle cerebral artery (MCA) associated with MMD are rare, with only 25 cases described in the literature. Methods:Search on the PubMed platform, in English, with the MeSH terms “Moyamoya Disease”, “Intracranial Aneurysm” and “Middle Cerebral Artery”. There were 151 results, of which 7 were included in the review. Results:Sumi et al. and Larson et al. reported non-ruptured IA of the M1 segment, treated by surgical clipping and wrapping, respectively. Endo et al. chose to clip a ruptured IA in the M1 segment, followed by anastomosis between the superficial temporal artery and the MCA, excluding the IA . Liu et al. reported a non-ruptured MCA IA in a pediatric patient, treated through an encephalo-duro-arterio-synangiosis; the IA was excluded. Peltier et al. performed an indirect revascularization using the multiple bur-hole technique in a pediatric patient with non-ruptured IA in the M1 segment, excluding the IA. Rivera et al. opted for the conservative approach of a ruptured IA in the M1 segment, which was successful. Yan et al. described 19 IA in the MCA associated with the MMD, without specifying the adopted therapeutic. Conclusion:Due to the low number of cases, no recommendation can be made, and treatment should be individualized.

Simplified Azygos Anterior Cerebral Bypass: Y-Shaped Superficial Temporal Artery Interposition Graft From A2 With Double Reimplantation of Pericallosal Arteries: Technical Case Report

2012 ◽  
Vol 72 (2) ◽  
pp. onsE235-onsE240 ◽  
Author(s):  
Jorge Mura ◽  
Francisco Riquelme ◽  
José Luis Cuevas ◽  
Felipe Luna ◽  
Pablo Vizhñay
Keyword(s):  
Saphenous Vein Graft ◽  
Therapeutic Option ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Graft ◽  
Skull Base Lesions ◽  
The Right ◽  
Cerebral Bypass ◽  
Revascularization Procedures

Abstract BACKGROUND AND IMPORTANCE: Trapping with distal revascularization is a therapeutic option for giant aneurysms that cannot be clipped or coiled. In skull base lesions such as meningiomas, arterial encasement is often present, requiring, in some cases, revascularization procedures: extracranial-to-intracranial bypass and more recently intracranial-to-intracranial techniques. These techniques are used only in exceptional cases of tumors in other localizations. CLINICAL PRESENTATION: We report a case of a recurrent malignant frontal falx meningioma with encasement of both pericallosal arteries (PcaAs). During resection of the lesion, the left PcaA was sectioned and the right PcaA was occluded for manipulation and coagulation of the tumor. The occlusion was diagnosed with indocyanine green video-angiography. A Y-shaped superficial temporal artery graft was obtained in the right side, and the anterior cerebral artery circulation was reconstructed using an intracranial-to-intracranial bypass in the following fashion: right A2 to superficial temporal artery Y-shaped graft for both PcaAs. The patient's postoperative period was uneventful with no deficit, and the computed tomography angiography showed the preservation of both PcaAs. CONCLUSION: To the best of our knowledge, this microsurgical reconstruction of the PcaAs has not been performed before in a meningioma or a complex aneurysm case. We think the use of a superficial temporal artery as an in situ graft is more straightforward compared with other interposition grafts such as the radial artery graft or saphenous vein graft. The use of intracranial-to-intracranial techniques is the proper evolution of the use of classic extracranial-to-intracranial cerebral revascularization techniques.

Endovascular Management of Symptomatic Spasm of Radial Artery Bypass Graft

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 794-798 ◽  
Author(s):  
Sabareesh K. Natarajan ◽  
Erik F. Hauck ◽  
L. Nelson Hopkins ◽  
Elad I. Levy ◽  
Adnan H. Siddiqui
Keyword(s):  
Radial Artery ◽  
Moyamoya Disease ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Occipital Artery ◽  
Artery Bypass Graft ◽  
Perfusion Deficit ◽  
Radial Artery Graft ◽  
Symptomatic Vasospasm ◽  
Artery Graft

Abstract OBJECTIVE To describe the technique of endovascular access for treatment of vasospasm of a radial artery bypass graft from the occipital artery to the M3 branch of the middle cerebral artery (MCA) in a patient with moyamoya disease. CLINICAL PRESENTATION A 32-year-old woman presented with recurrent right-sided ischemic symptoms in the territory of a previous stroke. Angiographic findings were consistent with moyamoya disease, and a perfusion deficit was identified on computed tomography (CT) perfusion imaging. TECHNIQUE The patient underwent a left MCA bypass graft for flow augmentation. She returned with an occluded bypass graft, collateralization of the anterior MCA territory through a spontaneous synangiosis, and a severe perfusion deficit in the posterior MCA territory. She underwent a revision bypass graft procedure with the radial artery from the occipital artery stump to the MCA-M3 branch. She developed repeated symptomatic vasospasm of the radial artery graft postoperatively. After systemic anticoagulation, the graft was accessed through the occipital artery, and intra-arterial verapamil was injected. When this failed to resolve the graft spasm, the radial artery graft was accessed with a 0.14-inch Synchro-2 microwire (Boston Scientific, Natick Massachusetts), and sequential angioplasties were performed using over-the-wire balloons from the proximal to distal anastomosis and in the occipital artery stump. A nitroglycerin patch was applied cutaneously over the graft to relieve the vasospasm. RESULTS No complications occurred. Graft patency with robust flow was observed on the 5-month follow-up angiogram. CONCLUSION Endovascular techniques can be safely used for salvage of spastic extracranial-intracranial grafts.

scholarly journals Revascularization Using a Superficial Temporal Artery Graft to Replaced a Failed Encephalo-myo-synangiosis in a Moyamoya Disease Patient

1994 ◽  
Vol 3 (2) ◽  
pp. 150-154
Author(s):  
Hajime Touho ◽  
Hidekazu Takahashi ◽  
Jun Krasawa ◽  
Hideyuki Ohnishi ◽  
Hiroyuki Nakase ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Disease Patient ◽  
Temporal Artery ◽  
Artery Graft

scholarly journals A case report: An increased oxygen extraction fraction in remote ischemic lesions after revascularization for moyamoya disease with a progression of posterior cerebral artery stenosis

2021 ◽  
Vol 10 (9) ◽  
pp. 205846012110472
Author(s):  
Kanako Kawanami ◽  
Yasuaki Kokubo ◽  
Shinji Sato ◽  
Hiroshi Itagaki ◽  
Yukihiko Sonoda
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Cerebral Metabolism ◽  
Superficial Temporal Artery ◽  
Oxygen Extraction Fraction ◽  
Oxygen Extraction ◽  
Occipital Artery ◽  
Ischemic Lesion ◽  
Extraction Fraction

The cerebral metabolism, such as the oxygen extraction fraction (OEF), in remote ischemic lesions following revascularization for moyamoya disease (MMD) has not yet been fully elucidated. We herein report a patient with an increased OEF in a remote ischemic lesion after revascularization in a case of adult-onset MMD. A 21-year-old woman suffered from a left parietal lobe infarction due to MMD. At 2 months after onset, left superficial temporal artery (STA)–middle cerebral artery (MCA) bypass and encephalo-myo-synangiosis (EMS) were performed. The postoperative course was uneventful. 15O-positron emission tomography (PET) performed at 2 months after the first operation revealed an increased OEF in the contralateral (right) frontal lobe that was suspected of being possible remote ischemia. The patient underwent right STA-MCA bypass and EMS. 15O-PET at 14 days after the second operation revealed an increased OEF in the contralateral (left) occipital lobe that was suspected of potentially being remote ischemia caused by a watershed shift. Two years after the second surgery, left occipital artery (OA)–posterior cerebral artery (PCA) anastomosis and EMS were performed due to transient right hemianopsia. Neither rebleeding nor ischemic complications occurred 2 years after the third surgery. We need to be alert for the possible progression of PCA stenosis in MMD after revascularization. It might induce remote ischemia after revascularization. OA–PCA bypass is therefore considered to be an effective treatment option in such cases.

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