Reversal of intracerebral steal by STA-MCA anastomosis

1982 ◽  
Vol 57 (5) ◽  
pp. 629-632 ◽  
Author(s):  
John P. Laurent ◽  
Pablo M. Lawner ◽  
Michael O'Connor
Keyword(s):  
Perfusion Pressure ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Arterial System ◽  
Low Flow ◽  
Neurological Deficits ◽  
Mean Flow ◽  
Content Type ◽  
Blood Flows ◽  
Fine Print

✓ A major factor determining the severity of neurological deficits caused by cerebral ischemia is the ability of the vasculature to provide collateral circulation to the ischemic areas. By establishing a major conduit by means of extracranial-intracranial anastomosis, the increased perfusion pressure through the collateral arterioles may reduce morbidity in these patients. Twenty-seven patients were selected for superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis based on clinical and angiographic evidence of lesions of the internal carotid arterial system. Cerebral blood flows (CBF's) were determined by the xenon-133 inhalation method using 16 symmetrically placed scintillator probes; two-compartment analysis was used to compute a mean flow for the compartment. An average mean flow was computed for each hemisphere, and for four regions with the lowest mean CBF in each hemisphere. The CBF was measured preoperatively and within 8 weeks postoperatively. The average mean flow was 29 ml/100 gm/min in the symptomatic hemisphere, and 30 ml/100 gm/min in the asymptomatic hemisphere. In 11 patients, the mean flow for the symptomatic hemisphere increased by 24% postoperatively, and for the asymptomatic hemisphere by 23%. Regions with lowest CBF showed an increase of 32% in the symptomatic hemisphere, and of 35% in the asymptomatic hemisphere. The low-flow regions differed from the total hemisphere (symptomatic: p < 0.02; asymptomatic: p < 0.05). Areas of lowest blood flow preoperatively had the greatest increase in flow postoperatively. Postoperative elevation of CBF in the contralateral hemisphere is consistent with an “intracerebral steal” before surgery. The postoperative elevation of flow in the asymptomatic hemisphere is related to improved perfusion pressure in the symptomatic hemisphere.

Treatment of bilateral mycotic intracavernous carotid aneurysms

1982 ◽  
Vol 56 (3) ◽  
pp. 443-447 ◽  
Author(s):  
Tsuneyoshi Eguchi ◽  
Tadayoshi Nakagomi ◽  
Akira Teraoka
Keyword(s):  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Systemic Blood Pressure ◽  
Neurological Deficits ◽  
Systemic Blood ◽  
Content Type ◽  
Carotid Aneurysms ◽  
The Right ◽  
Fine Print

✓ A case of bilateral mycotic intracavernous carotid aneurysms is reported. Because of progressive bilateral ophthalmoplegia, the internal carotid artery (ICA) was ligated on both sides, combined with bilateral extracranial-intracranial arterial bypass. A superficial temporal artery-middle cerebral artery anastomosis was performed first on the right side followed by ligation of the right ICA at the neck. After an interval of 20 days, a bypass and ICA ligation was carried out on the left side. The patient developed mild hemiparesis and dysphasia during and immediately after the second operation, but these neurological deficits disappeared after elevation of systemic blood pressure.

Superficial temporal-middle cerebral artery bypass: clinical pre- and postoperative angiographic correlation

1988 ◽  
Vol 69 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Clifford R. Jack ◽  
Thoralf M. Sundt ◽  
Nicolee C. Fode ◽  
Dale G. Gehring
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Arterial System ◽  
Collateral Flow ◽  
Content Type ◽  
Fine Print

✓ Between 1974 and 1982, an anastomosis between a pedicle of the superficial temporal artery (STA) and a cortical branch of the middle cerebral artery (MCA) was performed in 163 carotid systems in 157 patients for internal carotid artery occlusion in whom postoperative angiograms were available for analysis. The angiographic opacification of the arterial system was correlated with the patient's preoperative neurological function and stroke in the follow-up period. From this analysis, the following observations were made: 1) 96% of bypasses were patent; 2) 80% of bypasses achieved a high or medium MCA filling score; 3) there was hypertrophy of the STA in 70% of the cases; 4) greater bypass filling occurred in hemispheres with nonvisualized preoperative collateral circulation than in those with readily visualized collateral flow; 5) a meaningful correlation between angiographically assessed postoperative bypass function and stroke rate was not possible because only four patients suffered an ipsilateral hemispheric stroke in the 8-year follow-up period; and 6) patients who were neurologically unstable before the procedure were at greatest risk for a stroke in the follow-up period. It is apparent that objective analysis of the effectiveness of an STA-MCA bypass, or any other form of extracranial bypass, must await the development of new diagnostic studies in which high-resolution three-dimensional quantification of cerebral blood flow is possible. These studies will necessarily be correlated with preoperative and follow-up clinical data.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Treatment of aneurysms by excision or trapping with arterial reimplantation or interpositional grafting

1996 ◽  
Vol 85 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Sang Youl Lee ◽  
Laligam N. Sekhar
Keyword(s):  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Content Type ◽  
First Case ◽  
Cerebellar Artery ◽  
Fine Print

✓ The authors report three cases of ruptured, large or giant aneurysms that were treated by excision or trapping, followed by revascularization of distal vessels by means of arterial reimplantation or superficial temporal artery interpositional grafting. In the first case, a large serpentine aneurysm arising from the anterior temporal branch of the right middle cerebral artery (MCA) was excised and the distal segment of the anterior temporal artery was reimplanted into one of the branches of the MCA. In the second case, a giant aneurysm, fusiform in shape, arose from the rolandic branch of the MCA. This aneurysm was totally excised and the M3 branch in which it had been contained was reconstructed with an arterial interpositional graft. In the third case the patient, who presented with a subarachnoid hemorrhage, had a dissecting aneurysm that involved the distal portion of the left vertebral artery. In this case the posterior inferior cerebellar artery (PICA) arose from the wall of the aneurysm and coursed onward to supply the brainstem. This aneurysm was managed by trapping and the PICA was reimplanted into the ipsilateral large anterior inferior cerebellar artery. None of the patients suffered a postoperative stroke and all recovered to a good or excellent postoperative condition. These techniques allowed complete isolation of the aneurysm from the normal blood circulation and preserved the blood flow through the distal vessel that came out of the aneurysm. These techniques should be considered as alternatives when traditional means of cerebral revascularization are not feasible.

Intraoperative angiography using a portable digital subtraction unit

1986 ◽  
Vol 64 (5) ◽  
pp. 816-818 ◽  
Author(s):  
Kevin T. Foley ◽  
Leslie D. Cahan ◽  
Grant B. Hieshima
Keyword(s):  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Digital Subtraction ◽  
High Quality ◽  
Intraoperative Angiography ◽  
Content Type ◽  
Imaging Capability ◽  
Intracranial Vessel ◽  
Important Improvement ◽  
Fine Print

✓ A portable digital subtraction unit has been used in the operating room as an important improvement in obtaining high-quality intraoperative angiograms. This digital subtraction system offers several advantages over previously described techniques for intraoperative studies. Not only are the images of good quality, but also the dose of contrast medium is reduced and a real-time imaging capability allows the surgeon to visualize the passage of contrast agent dynamically. Arterial injections may be performed by selective femoral cerebral catheterization, puncture of the cervical carotid artery, retrograde catheterization via the superficial temporal artery, or puncture of an intracranial vessel at the time of surgery.

Study of the posterior circulation in moyamoya disease

1986 ◽  
Vol 65 (4) ◽  
pp. 454-460 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Izumi Nagata ◽  
Ikuo Ihara ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Occipital Lobe ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
Juvenile Onset ◽  
Content Type ◽  
Field Defect ◽  
Visual Disturbances ◽  
Fine Print

✓ The involvement of the posterior circulation in moyamoya disease was studied in 178 patients. Forty-three had several types of disturbance such as visual field defect, decreased visual acuity, episodes of blindness, and scintillating scotomata. Most of these symptoms were attributed to occlusive lesions in the posterior circulation. Visual disturbances were seen more often in patients with a juvenile onset than in cases of adult onset. Superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis and encephalomyosynangiosis (EMS) improved the cerebral perfusion both in the anterior and posterior circulation by redistribution of blood. In most cases, the visual symptoms subsided or were stabilized after STA-MCA anastomosis and EMS. These surgical procedures did not, however, lead to direct revascularization in cases of ischemia in the visual cortex. In five patients with impending blindness, transplantation of the omentum to the occipital lobe led to improved vision.

Pitfalls in the surgical treatment of moyamoya disease

1988 ◽  
Vol 68 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Izumi Nagata ◽  
Naohiro Yamazoe ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Middle Cerebral Artery ◽  
Moyamoya Disease ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Content Type ◽  
Cerebral Ischemic ◽  
Revascularization Procedures ◽  
Scalp Arteries ◽  
Fine Print

✓ Eleven cases of moyamoya disease refractory to indirect non-anastomotic revascularization, including encephalomyosynangiosis in two, encephaloduroarteriosynangiosis in seven, and encephalomyoarteriosynangiosis in two, are described. The patients suffered from recurrent cerebral ischemic symptoms, and further operative intervention, including superficial temporal artery-middle cerebral artery anastomosis and intracranial omental transplantation, was performed. The choice of operative maneuver depended on the availability of scalp arteries and on the nature of the ischemic symptoms. Although indirect non-anastomotic revascularization procedures have the advantage of technical ease and most patients respond to these procedures alone, there are some patients like the 11 presented here who are not cured by such procedures. In such cases, direct anastomotic revascularization is necessary for the prevention of stroke.

Superficial temporal-middle cerebral artery anastomosis associated with glioblastoma multiforme

1977 ◽  
Vol 46 (3) ◽  
pp. 381-384
Author(s):  
Joseph F. Cusick ◽  
Senichiro Komacki ◽  
Hongyung Choi
Keyword(s):  
Glioblastoma Multiforme ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Surgical Anastomosis ◽  
Content Type ◽  
Fine Print ◽  
Temporal Middle

✓ The authors report a case in which glioblastoma multiforme was intimately associated with a surgical anastomosis of the superficial temporal artery to a branch of the middle cerebral artery.

scholarly journals Traumatic Arteriovenous Fistula of the Scalp in the Left Temporoparietal Region with Intra- and Extracranial Blood Supply

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Feng Zheng ◽  
Herbert Augustus Pitts ◽  
Roland Goldbrunner ◽  
Boris Krischek
Keyword(s):  
Arteriovenous Fistula ◽  
Blood Supply ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
High Flow ◽  
Arterial System ◽  
Low Flow ◽  
Radiological Features ◽  
Feeding Vessels ◽  
Capillary Bed

Traumatic AVF of the scalp is a rare abnormal vascular disease. It is defined as a communication between the high flow arterial system and the low flow venous network, which directly connects the arterial feeding vessels of the scalp and the draining veins without an intervening capillary bed. The superficial temporal artery (STA) was involved in 90% of the cases, and 71% of the patients only had one dominant feeding STA. Here, we report the case of a rare large traumatic arteriovenous fistula (AVF) of the scalp that is fed by intra- and extracranial blood supply. The clinical and radiological features are presented, and the possible pathogenesis and surgical technique are discussed.

Intracranial vascular anastomosis using the microanastomotic system

1998 ◽  
Vol 89 (4) ◽  
pp. 676-681 ◽  
Author(s):  
David W. Newell ◽  
Andrew T. Dailey ◽  
Stephen L. Skirboll
Keyword(s):  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Collateral Flow ◽  
Content Type ◽  
History Of ◽  
End To End ◽  
Fine Print

✓ The authors describe the use of a microanastomotic device to perform intracranial end-to-end vascular anastomoses. Direct end-to-end anastomosis was performed between the superficial temporal artery and branches of the middle cerebral artery (MCA) in three patients. Two patients had moyamoya disease, with severe proximal MCA disease, and one suffered an internal carotid artery occlusion with poor collateral flow. All patients reported a history of recent ischemic symptoms. Each anastomosis was accomplished in less than 15 minutes with technically satisfactory results. Postoperative angiographic studies demonstrated patency of the bypasses in all patients.

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