End-to-side anastomosis of small vessels using an Nd:YAG laser with a hemispherical contact probe

1992 ◽  
Vol 76 (3) ◽  
pp. 546-549 ◽  
Author(s):  
Cornelis A. F. Tulleken ◽  
Andries van Dieren ◽  
Ruud M. Verdaasdonk ◽  
Wim Berendsen
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Nd:Yag Laser ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Content Type ◽  
Small Vessels ◽  
Contact Probe ◽  
A New Technique ◽  
Fine Print

✓ A new technique is described which enables the surgeon to perform an end-to-side anastomosis between arteries with little (< 2 minutes) or no occlusion of the recipient artery. The technique was developed in rabbits, but has recently been successfully used in a patient in whom an anastomosis between the superficial temporal artery and a proximal branch of the middle cerebral artery was created.

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.

Spontaneous cerebral revascularization in a patient with STA-MCA anastomosis

1976 ◽  
Vol 44 (1) ◽  
pp. 84-87 ◽  
Author(s):  
James I. Ausman ◽  
James Moore ◽  
Shelley N. Chou
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Cerebral Revascularization ◽  
Surgical Anastomosis ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors report a case with spontaneous revascularization of the brain after surgical anastomosis of the superficial temporal artery to the middle cerebral artery.

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.

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.

A Novel Minimally Occlusive Microvascular Anastomosis Technique Using a Temporary Intraluminal Shunt: A Prospective Technique to Minimize Brain Ischemia Time during Superficial Temporal Artery-to-Middle Cerebral Artery Bypass

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. 191-198 ◽  
Author(s):  
Kartik G. Krishnan ◽  
Papuna Tsirekidze ◽  
Thomas Pinzer ◽  
Gabriele Schackert
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Abdominal Aorta ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
New Technique ◽  
Microvascular Anastomosis ◽  
Occlusion Time ◽  
A New Technique

Abstract OBJECTIVE: To describe a new technique of suturing microvessels with persistent perfusion via a temporary intraluminal microshunt. METHODS: Experiments were conducted in Wistar rats. Abdominal aorta grafts were explanted from donor rats. A soft silicon microcatheter was introduced into the lumen of this graft. The abdominal aorta of a recipient rat was prepared for end-to-side microvascular anastomosis. Acland clamps (S&T AG, Neuhausen, Switzerland) were applied, and a linear arteriotomy was made. One end of the graft-clad microcatheter was introduced into the lumen and occluded with a fenestrated Acland clamp. At a more distal part, a similar arteriotomy was performed, and the other end of the microcatheter was introduced into the lumen and clamped with a fenestrated Acland clip. This created a temporary shunt through the graft-clad microcatheter. Then, the graft was anastomosed to the arteriotomies at both ends, over the microcatheter, in an end-to-side manner. The microcatheter was explanted from the vessel lumen through an arteriotomy in the middle of the graft. The graft was clipped short to close this arteriotomy. The mean total occlusion time before perfusion was reestablished amounted to 3.7 minutes. This experiment was repeated in 12 animals (6 with and 6 without heparin) without technical complications. As controls, conventional anastomoses were made in 2 animals. RESULTS: Suturing microvessels mandates their occlusion during the period of anastomosis. Although ischemia is well tolerated by other tissue types, the brain is quite sensitive to even short windows of ischemia. Nonocclusive anastomotic techniques have been developed recently. These are confined to vessels with luminal diameters greater than 3 mm. We have evolved a novel technique that can be used with microvessels, as pertinent to superficial temporal artery-to-middle cerebral artery bypass. CONCLUSION: We have described a new technique for performing microvascular anastomoses over a temporary intraluminal microcatheter shunt.

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.

Subclavian to middle cerebral artery saphenous vein bypass graft

1980 ◽  
Vol 53 (4) ◽  
pp. 465-469 ◽  
Author(s):  
Robert F. Spetzler ◽  
Robert S. Rhodes ◽  
Richard A. Roski ◽  
Matt J. Likavec
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Superficial Temporal Artery ◽  
Head Rotation ◽  
Temporal Artery ◽  
Additional Advantage ◽  
Content Type

✓ A variation of an extracranial-intracranial arterial bypass is presented. The subclavian artery is used as the donor vessel and the saphenous vein as the graft; thus, a bypass to a cortical branch of the middle cerebral artery can be accomplished. The advantage of this modification is that the saphenous vein, when tunneled subcutaneously behind the ear, is positioned in a straight line from the donor to the recipient vessel. Since the vein lies in the axis of head rotation, turning of the head causes little displacement of the graft, as opposed to a graft from the common carotid artery to the middle cerebral artery. An additional advantage over the superficial temporal artery to middle cerebral artery bypass is the large flow obtained immediately after anastomosis.

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 artery to middle cerebral artery anastomosis

1979 ◽  
Vol 50 (5) ◽  
pp. 560-569 ◽  
Author(s):  
John R. Little ◽  
Y. Lucas Yamamoto ◽  
William Feindel ◽  
Ernst Meyer ◽  
Charles P. Hodge
Keyword(s):  
Middle Cerebral Artery ◽  
Fluorescein Angiography ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Anastomotic Site ◽  
Regional Cerebral Blood ◽  
Severe Stenosis ◽  
Content Type ◽  
Clearance Studies

✓ Fluorescein angiography and xenon-133 (133Xe) clearance studies were performed during surgery on 15 patients who were undergoing superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis. Fourteen patients had occlusive disease of the internal carotid artery (ICA), and one patient had severe stenosis of the MCA. Before anastomosis, fluorescein angiography showed slow filling of the MCA branches through collateral channels. Focal areas of impaired microcirculatory filling and washout were seen in the territory of severely sclerotic cortical arteries. The findings of preanastomotic 133Xe clearance studies were variable and a uniform pattern of regional cerebral blood flow (rCBF) changes was not defined. In 55% of the patients, rCBF was reduced to 25 ml/100 gm/min or less at one or more detector sites. Fluorescein angiography provided an immediate assessment of anastomotic patency and clearly displayed the distribution of blood entering the epicerebral circulation through the STA. In 67% of patients, multiple MCA cortical branches filled with fluorescein, whereas in 33% filling was restricted to the receptor artery territory. An immediate, substantial (≥ 15 ml/100 gm/min) increase in rCBF was demonstrated in 73% of patients after anastomosis. The rCBF changes were consistently better in patients with donor and receptor arteries greater than 1 mm in diameter. Redistribution of collateral input acted to increase rCBF in areas distant from the anastomotic site. Some improvement in fluorescein circulation and rCBF also was seen in cortex supplied by sclerotic MCA branches.

Giant serpentine middle cerebral artery aneurysm treated by extracranial-intracranial bypass

1993 ◽  
Vol 78 (6) ◽  
pp. 974-978 ◽  
Author(s):  
Karl A. Greene ◽  
John A. Anson ◽  
Robert F. Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Left Middle Cerebral Artery ◽  
Content Type ◽  
Serpentine Aneurysm ◽  
Aneurysmal Neck ◽  
Cerebral Artery Aneurysm

✓ Giant intracranial aneurysms often pose difficult management issues. Such aneurysms may not be amenable to direct surgical attack because of their size, location, or lack of a clear aneurysmal neck. In such cases, a combination of strategies may provide a means of proximal aneurysm occlusion and distal cerebral revascularization. The authors report the successful treatment of a giant (186.8-ml) serpentine aneurysm of the left middle cerebral artery (MCA) in a 14-year-old boy. The aneurysm was managed in a two-stage procedure in which the MCA branches distal to the aneurysm were anastomosed first with branches of the left superficial temporal artery. After the bypass procedure, direct occlusion of the MCA was performed at the proximal base of the aneurysm at its site of dilatation. The patient had no intraoperative or postoperative complications and was intact neurologically 6 months following the procedures.

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