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.

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.

Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis

1979 ◽  
Vol 50 (3) ◽  
pp. 377-381 ◽  
Author(s):  
Paul Steinbok ◽  
Kenneth Berry ◽  
Clarisse L. Dolman
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intimal Hyperplasia ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Revascularization ◽  
Revascularization Procedure ◽  
Content Type ◽  
The Media ◽  
Fine Print

✓ Superficial temporal artery to middle cerebral artery (STA-MCA) anastomoses were examined at autopsy in two patients who survived 2 years and 5½ years, respectively, after the cerebral revascularization procedure. Identification of the actual anastomotic sites at autopsy was rendered impossible because of marked fibrosis in the region of the surgery. However, in both patients intimal fibrosis and medial damage were noted in the STA immediately adjacent to the anastomosis. In the patient who survived 2 years, the lumen of the STA was only slightly compromised by these changes, but in the patient who survived 5½ years, the artery was almost totally occluded. The MCA's adjacent to the anastomosis were widely patent and showed focal areas of intimal hyperplasia with no abnormalities of the media.

Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms

1991 ◽  
Vol 74 (1) ◽  
pp. 133-135 ◽  
Author(s):  
Kevin Gibbons ◽  
Leo N. Hopkins ◽  
Roberto C. Heros
Keyword(s):  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Anterior Communicating Artery ◽  
Case Histories ◽  
Content Type ◽  
Anterior Communicating Artery Aneurysms ◽  
Artery Segment ◽  
Distal Anterior Cerebral Artery ◽  
Clip Occlusion ◽  
Fine Print

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.

Endovascular stenting for rescue of a failed donor graft during superficial temporal artery to middle cerebral artery bypass surgery: case report

2019 ◽  
Vol 24 (5) ◽  
pp. 572-576
Author(s):  
Melissa A. LoPresti ◽  
Visish M. Srinivasan ◽  
Robert Y. North ◽  
Vijay M. Ravindra ◽  
Jeremiah Johnson ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Endovascular Management ◽  
Donor Graft ◽  
Mca Aneurysm ◽  
Direct Bypass

Direct bypass has been used to salvage failed endovascular treatment; however, little is known of the reversed role of endovascular management for failed bypass.The authors report the case of a 7-year-old patient who underwent a superficial temporal artery to middle cerebral artery (STA-MCA) bypass for treatment of a giant MCA aneurysm and describe the role of endovascular rescue in this case. Post-bypass catheter angiogram showed occlusion of the proximal extracranial STA donor with patent anastomosis, possibly due to STA dissection. A self-expanding Neuroform Atlas stent was deployed across the dissection flap, and follow-up images showed revascularization of the STA with good MCA runoff.This case demonstrates that direct extracranial-intracranial bypass failure can infrequently originate from the STA donor vessel and that superselective angiogram can be useful for identification and treatment in such cases. With more advanced endovascular techniques the tide has turned in the treatment of complex cerebrovascular cases, with this case being an early example of successful rescue stenting for endovascular management of a failed donor after STA-MCA bypass.

Anastomosis of the anterior temporal artery to a secondary trunk of the middle cerebral artery for treatment of a giant M1 segment aneurysm

1992 ◽  
Vol 76 (5) ◽  
pp. 863-866 ◽  
Author(s):  
Joshua B. Bederson ◽  
Robert F. Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Clinical Course ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Suture Line ◽  
Arterial Segment ◽  
Content Type ◽  
Proximal Middle Cerebral Artery

✓ The clinical course, operative technique, and angiographic outcome are reported for a patient with a giant intracranial aneurysm of the proximal middle cerebral artery (MCA) who presented with symptoms of ischemia. Treatment of the aneurysm required bypassing the involved MCA bifurcation, but the patient lacked a suitable donor superficial temporal artery. The involved arterial segment was therefore bypassed with a side-to-side anastomosis of the anterior temporal artery to one of the secondary trunks of the MCA. This bypass eliminated the need to harvest a vein graft and re-established flow using in situ intracranial vessels of similar diameter, minimal arterial dissection, and only one suture line.

scholarly journals Superficial temporal artery to middle cerebral artery bypass: past, present, and future

2008 ◽  
Vol 24 (2) ◽  
pp. E2 ◽  
Author(s):  
Marcelo D. Vilela ◽  
David W. Newell
Keyword(s):  
Middle Cerebral Artery ◽  
Skull Base ◽  
Cerebral Vasospasm ◽  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Skull Base Tumors ◽  
Intracranial Atherosclerotic Disease

Object The aim of this study was to review the historical developments and current status of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. Method A literature review was performed to review the origins and current uses of the STA bypass procedure in neurosurgery. Results The idea of providing additional blood supply to the brain to prevent stroke and maintain neurological function has been present in the mind of neurosurgeons for many decades. In 1967 the first STA–MCA bypass was done by M. G. Yaşargil, and an enormous step was made into the field of microneurosurgery and cerebral revascularization. During the decades that followed, this technique was used as an adjuvant or a definitive surgical treatment for occlusive disease of the extracranial and intracranial cerebral vessels, skull base tumors, aneurysms, carotid–cavernous fistulas, cerebral vasospasm, acute cerebral ischemia, and moyamoya disease. With the results of the first randomized extracranial–intracranial (EC–IC) bypass trial and the development of endovascular techniques such as angioplasty for intracranial atherosclerotic disease and cerebral vasospasm, the indications for STA–MCA bypass became limited. Neurosurgeons continued to perform EC–IC bypasses as an adjuvant to clipping of aneurysms and in the treatment of skull base tumors and moyamoya disease; the procedure is less commonly used for atherosclerotic carotid artery occlusion (CAO) with definite evidence of hemodynamic insufficiency. The evidence that patients with symptomatic CAO and “misery perfusion” have an increased stroke risk has prompted a second trial for evaluating EC–IC bypass for stroke prevention. The Carotid Occlusion Surgery Study is a new trial designed to determine whether STA–MCA bypass can reduce the incidence of stroke in these patients. New trials will also reveal the role of the STA–MCA bypass in the prevention of hemorrhages in moyamoya disease. Conclusions The role of STA–MCA bypass in the management of cerebrovascular disease continues to be refined and evaluated using advanced imaging techniques and by performing randomized trials for specific purposes, including symptomatic CAO.

Saccular aneurysms of the distal anterior cerebral artery

1974 ◽  
Vol 40 (2) ◽  
pp. 218-223 ◽  
Author(s):  
M. Gazi Yaşargil ◽  
L. Philip Carter
Keyword(s):  
Cerebral Artery ◽  
Subarachnoid Space ◽  
Operative Mortality ◽  
Anterior Cerebral Artery ◽  
Operative Morbidity ◽  
Content Type ◽  
Interhemispheric Fissure ◽  
Distal Anterior Cerebral Artery ◽  
Fine Print ◽  
Saccular Aneurysms

✓ A series of 13 patients with saccular aneurysms of the distal anterior cerebral artery, operated on by the same surgeon with microtechniques, is reviewed. The incidence of aneurysms in this location was 3.4%, the median age of the patients 44 years, and the median time from most recent hemorrhage to surgery 13 days. There were five cases of multiple aneurysms. No operative mortality occurred; the operative morbidity was 15%. Because of their multiplicity, characteristic broad base, and the small subarachnoid space in the interhemispheric fissure, these aneurysms are judged technically difficult.

Cranial burr hole for revascularization in moyamoya disease

1989 ◽  
Vol 71 (2) ◽  
pp. 180-185 ◽  
Author(s):  
Masataka Endo ◽  
Nobuyuki Kawano ◽  
Yoshio Miyasaka ◽  
Kenzoh Yada
Keyword(s):  
Moyamoya Disease ◽  
Cerebral Artery ◽  
Clinical Symptoms ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Burr Hole ◽  
Frontal Region ◽  
External Carotid ◽  
Content Type ◽  
Made In

✓ Currently, superficial temporal artery-middle cerebral artery (MCA) anastomosis, encephalomyosynangiosis (EMS), and encephalo-duro-arterio-synangiosis are used to treat moyamoya disease and are reported to effectively improve ischemic symptoms. All are methods of reversing the flow of blood from the external carotid artery system into the cortical branches of the MCA. As moyamoya disease advances, these operations alone will predictably not correct the deterioration in blood flow in the territory of the anterior cerebral artery. It was noted in a case of moyamoya disease with intraventricular hemorrhage that a burr hole, made in the frontal region for drainage purposes, induced marked neovascularization. Since then, similar frontal burr holes have been made in five juvenile cases of moyamoya disease; this procedure involved making a burr hole in both frontal bones and incising both the dura and the arachnoid membrane. In two cases a frontal burr hole was placed simultaneously with EMS, and in the others the frontal burr hole was made following EMS. The clinical symptoms improved after the frontal burr hole was made, and dynamic computerized tomography revealed improved circulation in the frontal regions. Together with conventional surgical therapy for juvenile cases of moyamoya disease, this operation is considered beneficial both to the circulation in the frontal region and for the protection of frontal brain function.

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