Surgical treatment for spontaneous carotid dissection with impending stroke

1984 ◽  
Vol 61 (2) ◽  
pp. 382-386 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Yoshihiro Kuriyama

✓ A case of spontaneous carotid artery dissection is presented. In the case described, superficial temporal artery-middle cerebral artery anastomosis was performed because of impending stroke. Surgical revascularization is indicated in a case that shows such a rapid evolution of stroke that spontaneous resolution of the dissection cannot be awaited.

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark

✓ 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.


1996 ◽  
Vol 85 (1) ◽  
pp. 178-185 ◽  
Author(s):  
Sang Youl Lee ◽  
Laligam N. Sekhar

✓ 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.


1986 ◽  
Vol 64 (5) ◽  
pp. 816-818 ◽  
Author(s):  
Kevin T. Foley ◽  
Leslie D. Cahan ◽  
Grant B. Hieshima

✓ 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.


1986 ◽  
Vol 65 (4) ◽  
pp. 454-460 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Izumi Nagata ◽  
Ikuo Ihara ◽  
...  

✓ 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.


1988 ◽  
Vol 68 (4) ◽  
pp. 537-543 ◽  
Author(s):  
Susumu Miyamoto ◽  
Haruhiko Kikuchi ◽  
Jun Karasawa ◽  
Izumi Nagata ◽  
Naohiro Yamazoe ◽  
...  

✓ 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.


1977 ◽  
Vol 46 (3) ◽  
pp. 381-384
Author(s):  
Joseph F. Cusick ◽  
Senichiro Komacki ◽  
Hongyung Choi

✓ 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.


2010 ◽  
Vol 17 (4) ◽  
pp. 569-573 ◽  
Author(s):  
Nazzareno Stella ◽  
Giovanni Palombo ◽  
Federico Filippi ◽  
Cristiano Fantozzi ◽  
Maurizio Taurino

1998 ◽  
Vol 89 (4) ◽  
pp. 676-681 ◽  
Author(s):  
David W. Newell ◽  
Andrew T. Dailey ◽  
Stephen L. Skirboll

✓ 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.


1982 ◽  
Vol 56 (3) ◽  
pp. 443-447 ◽  
Author(s):  
Tsuneyoshi Eguchi ◽  
Tadayoshi Nakagomi ◽  
Akira Teraoka

✓ 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.


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