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.

scholarly journals Use of radial artery grafts in extracranial–intracranial revascularization procedures

2008 ◽  
Vol 24 (2) ◽  
pp. E5 ◽  
Author(s):  
Hasan Kocaeli ◽  
Norberto Andaluz ◽  
Ondrej Choutka ◽  
Mario Zuccarello
Keyword(s):  
Radial Artery ◽  
Bypass Graft ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
High Flow ◽  
Low Flow ◽  
Collateral Flow ◽  
Parent Vessel ◽  
Clinical Series ◽  
Revascularization Procedures

✓Cerebral revascularization procedures have been used in the clinical management of actual or threatened cerebral ischemic states and unclippable cerebral aneurysms. An alternative to a low-flow bypass graft (for example, with the superficial temporal artery) is the use of high-flow grafts created using the saphenous vein (SV) or radial artery (RA). These high-flow grafts are particularly useful when otherwise adequate collateral flow is insufficient to enable sacrifice of the parent vessel without the risk of cerebral ischemia. In their clinical series of 13 patients who underwent high-flow bypass with an RA graft, the authors describe 8 women and 5 men whose ages ranged from 44 to 69 years (mean 57.84 ± 9.05 years). Indications for RA graft bypass were unclippable aneurysms in 10 patients and occlusive cerebrovascular disease in 3 patients. The authors review the properties of the 2 most common conduits, the SV and RA grafts. They present the technique of high-flow extracranial–intracranial bypass produced using RA grafts in the management of occlusive atherosclerotic disease and complex intracranial aneurysms that are not otherwise amenable to either clip ligation or coil occlusion.

Extracranial-Intracranial Arterial Bypass to a Single Branch of the Middle Cerebral Artery in the Management of a Traumatic Aneurysm

Neurosurgery ◽  
1979 ◽  
Vol 4 (4) ◽  
pp. 334-337 ◽  
Author(s):  
Robert F. Spetzler ◽  
Michael P. Owen
Keyword(s):  
Middle Cerebral Artery ◽  
Blood Supply ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Low Flow ◽  
Traumatic Aneurysm ◽  
Flow Demand ◽  
Adequate Blood Supply ◽  
Single Branch

Abstract This case required the clipping of a single branch of the middle cerebral artery for the treatment of a traumatic aneurysm. To ensure an adequate blood supply distal to the occlusion, we anastomosed the superficial temporal artery to that branch of the middle cerebral artery (MCA) distal to the aneurysm. Despite the low flow required to irrigate only one branch of the MCA, the anastomosis remained patent. This case demonstrates the feasibility of performing small vessel anastomoses in spite of low flow demand.

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.

Double-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass: Can It Be Considered “High-Flow?”

2017 ◽  
Vol 14 (3) ◽  
pp. 288-294 ◽  
Author(s):  
Jacob Cherian ◽  
Visish Srinivasan ◽  
Peter Kan ◽  
Edward AM Duckworth
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
High Flow ◽  
Low Flow ◽  
Flow Probe ◽  
Flow Measurements ◽  
The Impact ◽  
Probe Measurements

Abstract BACKGROUND Traditionally, superficial temporal artery-middle cerebral artery (STA-MCA) bypass uses one STA branch. Its augmentation of flow has classically been described as “low flow.” In a double-barrel STA-MCA bypass, however, both branches of the STA are utilized. Here we hypothesize that this should not be considered “low flow.” OBJECTIVE To review quantitative flow data from our cases and investigate the impact of double-barrel STA-MCA bypass on total flow augmentation, and to assess whether double-barrel STA-MCA bypass might be useful in situations that traditionally demand more complex bypass strategies. METHODS Intraoperative flow probe measurements from STA-MCA bypass cases were retrospectively tabulated and compared. Cut flow and bypass flow measurements were, respectively, taken before and after completion of anastomoses. The higher value was labeled best observed flow (BOF). RESULTS We identified 21 STA-MCA bypass cases with available intraoperative flow probe measurements, of which 17 utilized double-barrel technique. Only 1 STA branch was available in 4 cases. Significantly higher average BOF was seen when utilizing 2 STA branches (69 vs 39 cc/min, P &lt; .001). A majority (9/17) of double-barrel bypasses provided BOF ≥ 65 cc/min (120 cc/min maximum). The single branch bypass maximum BOF was 40 cc/min. CONCLUSION Double-barrel bypass technique significantly enhances STA-MCA flow capacity and may be useful in situations in which a high-flow bypass is needed. The 2 efferent limbs allow flexibility in distributing flow across separate at-risk territories. The method compares favorably to other descriptions of high-flow bypass without the morbidity of graft harvest or an additional cervical incision.

Spontaneous arteriovenous fistula of the superficial temporal artery misdiagnosed as hemangioma

2021 ◽  
Author(s):  
Gloria Juan‐Carpena ◽  
Juan Carlos Palazón‐Cabanes ◽  
José Ignacio Gallego‐León ◽  
María Niveiro ◽  
Isabel Betlloch‐Más
Keyword(s):  
Arteriovenous Fistula ◽  
Superficial Temporal Artery ◽  
Temporal Artery

Cerebral Hyperperfusion Syndrome by the Numbers: Transient Focal Neurological Deficit, Imaging-Proven Focal Hyperperfusion, and High Graft Flow Rate Following Superficial Temporal Artery-Middle Cerebral Artery bypass in a Patient With Symptomatic Carotid Occlusion—Case Report

2018 ◽  
Vol 15 (6) ◽  
pp. E94-E99 ◽  
Author(s):  
Ralph Rahme ◽  
Tejaswi D Sudhakar ◽  
Marjan Alimi ◽  
Timothy G White ◽  
Rafael A Ortiz ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Flow Rate ◽  
Perfusion Imaging ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Low Flow ◽  
Flow Rates ◽  
Cerebral Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Graft Flow

Abstract BACKGROUND AND IMPORTANCE Cerebral hyperperfusion syndrome (CHS) is a well-known complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass for ischemic cerebrovascular disease. While this argues against “low flow” in the bypass construct, flow rates in the graft have not been previously quantified in the setting of CHS. CLINICAL PRESENTATION A 58-yr-old man presented with recurrent left hemispheric ischemic strokes and fluctuating right hemiparesis and aphasia. Vascular imaging revealed left cervical internal carotid artery occlusion and perfusion imaging confirmed left hemispheric hypoperfusion. After failing to respond to maximal medical therapy, the patient underwent single-barrel STA-MCA bypass. Postoperatively, his symptoms resolved and blood pressure (BP) was strictly controlled within normal range. However, 2 d later, he developed severe expressive aphasia. CTA demonstrated a patent bypass graft and SPECT showed focal hyperperfusion in Broca's speech area. Seizure activity was ruled out. A high graft flow rate of 52 mL/min was documented by quantitative magnetic resonance angiography (MRA). Thus, the diagnosis of CHS was made and managed with strict BP control. The patient exhibited complete recovery of speech over a period of days and was discharged home. Repeat SPECT at 4 mo showed resolution of hyperperfusion and quantitative MRA demonstrated reduction of graft flow rate to 34 mL/min. CONCLUSION This is the first case of perfusion imaging-proven CHS after STA-MCA bypass, where high graft flow rates are objectively documented. Our observations constitute irrefutable evidence challenging the classic belief that the STA-MCA bypass is a low-flow construct.

scholarly journals Saphenous vein graft bypass in the treatment of giant cavernous sinus aneurysms: report of two cases

2000 ◽  
Vol 58 (1) ◽  
pp. 162-168 ◽  
Author(s):  
RICARDO RAMINA ◽  
MURILO S. MENESES ◽  
ARI A PEDROZO ◽  
WALTER O. ARRUDA ◽  
GUILHERME BORGES
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Brain Infarction ◽  
Superficial Temporal Artery ◽  
High Flow ◽  
Low Flow ◽  
External Carotid

Two cases of giant intracavernous aneurysms treated by high flow bypass with saphenous vein graft between the external carotid artery (ECA) and branches of the middle cerebral artery (MCA) are presented. Very often these aneurysms are unclippable because they are fusiform or have a large neck. Occlusion of the internal carotid artery (ICA) is the treatment of choice in many cases. This procedure has however a high risk of brain infarction. Revascularization of the brain by extra-intracranial anastomosis between the superficial temporal artery (STA) and branches of the MCA is frequently performed. This procedure provides however a low flow bypass and brain infarction may occur. We report two cases of giant cavernous sinus aneurysms treated by high flow bypass and endovascular balloon occlusion of the ICA. Immediate high flow revascularization of MCA branches was achieved and the patients showed no ischemic events. Follow-up of 8 and 14 months after operation shows patency of the venous graft and no neurological deficits. Angiographic control examination showed complete aneurysm occlusion in both cases.

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