scholarly journals Trans-sylvian Superficial Temporal Artery-Superior Cerebellar Artery Bypass: Procedure Development and Case Reports

2015 ◽  
Vol 43 (5) ◽  
pp. 321-328 ◽  
Author(s):  
Tsunenori OZAWA ◽  
Tadashi NAKAGAWA ◽  
Hiroshi MORI ◽  
Ken-ichi KAMADA ◽  
Satoshi KURABE ◽  
...  
Keyword(s):  
Case Reports ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Bypass Procedure ◽  
Cerebellar Artery ◽  
Procedure Development

Deep Bypasses to the Distal Posterior Circulation

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 92-101 ◽  
Author(s):  
Zsolt Zador ◽  
Daniel C. Lu ◽  
Christine M. Arnold ◽  
Michael T. Lawton
Keyword(s):  
Temporal Lobe ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Brain Shift ◽  
Morphometric Measurements ◽  
Subtemporal Approach ◽  
Cerebellar Artery

Abstract OBJECTIVE The subtemporal approach for a superficial temporal artery–to–superior cerebellar artery bypass requires significant superior retraction that can injure the temporal lobe, compromise veins, and cause edema postoperatively. In contrast, the pretemporal approach requires posterolateral retraction that seems to be less injurious to the temporal lobe and better tolerated clinically. We hypothesized that the pretemporal approach provides ample exposure, more gentle retraction, and better clinical results than the subtemporal approach. METHODS Standard orbitozygomatic-pterional and subtemporal approaches were performed on both sides of 4 formalin-fixed cadaver heads for morphometric measurements. Temporal lobe retraction was quantified for each approach in terms of brain shift and retraction pressure by using both sides of 3 fresh, unfixed cadaver heads. Similar morphometric measurements were made in 14 patients in whom bypasses to the distal posterior circulation were performed. The effect of temporal lobe retraction was assessed with edema volumes on postoperative computed tomography scans. RESULTS In cadaver heads and in patients, the pretemporal approach optimized exposure of the P2A segment of the posterior cerebral artery (PCA) and the subtemporal approach optimized exposure of the lateral pontomesencephalic segment of the superior cerebellar artery (SCA). Working depths and lengths of exposed artery were similar with these 2 approaches, but the PCA was a larger recipient than the SCA. Brain shift was 42% less with pretemporal than with subtemporal retraction, and retraction pressure was 43% less with pretemporal than with subtemporal retraction. The volume of temporal lobe edema was 56% less in patients with bypasses performed with the pretemporal approach as compared with the subtemporal approach. CONCLUSION Pretemporal exposure of the PCA is equivalent to subtemporal exposure of the SCA, but the pretemporal approach is facilitated by a larger recipient artery. Posterolateral temporal lobe retraction associated with the pretemporal approach is gentler than superior retraction with the subtemporal approach. These results validate our preference for the pretemporal approach over the subtemporal approach when performing deep bypasses to the posterior circulation.

Resolving Occlusive Lesions of the Basilar Artery

Neurosurgery ◽  
1985 ◽  
Vol 17 (5) ◽  
pp. 811-814 ◽  
Author(s):  
John R. Little ◽  
Anthony J. Furlan
Keyword(s):  
Basilar Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
The Other ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Basilar Artery Stenosis ◽  
Occlusive Lesion

Abstract Progression of severe basilar artery stenosis to occlusion is a well-recognized phenomenon, but regression of a severe basilar artery atherothrombotic lesion has not been described previously. In this report, two patients with a symptomatic severe basilar artery occlusive lesion showed substantial angiographic improvement after 3 months of anticoagulation in one case and 4 months after superficial temporal artery to superior cerebellar artery bypass in the other case. The findings in these cases indicate that clinical improvement in similar cases may reflect recanalization of a basilar artery occlusive lesion. The uncertain natural history and potential for regression of symptomatic basilar artery atherothormbosis make us hesitant to recommend posterior circulation revascularization immediately after such lesions are first demonstrated angiographically.

scholarly journals Superficial temporal artery–superior cerebellar artery bypass and trapping of a fusiform aneurysm using intradural anterior petrosectomy: technical case report and anatomical study

2019 ◽  
Vol 46 (2) ◽  
pp. E9
Author(s):  
Soichi Oya ◽  
Masahiro Indo ◽  
Masabumi Nagashima ◽  
Toru Matsui
Keyword(s):  
Artery Bypass ◽  
Treatment Options ◽  
Superficial Temporal Artery ◽  
Anatomical Study ◽  
Temporal Artery ◽  
Distal Portion ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Cerebellar Artery ◽  
Anterior Petrosectomy

Aneurysms at the distal portion of the superior cerebellar artery (SCA) are very rare. Because of the deep location and a propensity for nonsaccular morphology, aneurysm trapping or endovascular occlusion of the parent artery are the usual treatment options, which are associated with varying risks of ischemic complications. The authors report on a 60-year-old woman who had a 3.5-mm unruptured aneurysm in the lateral pontomesencephalic segment of the SCA with a significant interval growth to 8 mm. Direct surgical intervention comprising trapping of the aneurysm through a subtemporal approach and intradural anterior petrosectomy combined with revascularization of the distal SCA using the superficial temporal artery (STA) was performed. This approach provided sufficient space for the bypass instruments to be introduced into the deep surgical field at a more favorable angle to enhance microscopic visualization of the anastomosis with minimal retraction of the temporal lobe. The patient was discharged with no neurological deficit. Preservation of the blood flow in the distal SCA should be attempted to minimize the risk of ischemic injury, particularly when the aneurysms arise in the anterior or lateral segment of the SCA. The authors demonstrate the safety and effectiveness of the intradural anterior petrosectomy for STA-SCA bypass along with a relevant anatomical study.

Cerebral blood flow and metabolism following superficial temporal artery to superior cerebellar artery bypass for vertebrobasilar occlusive disease

1992 ◽  
Vol 76 (6) ◽  
pp. 955-960 ◽  
Author(s):  
Akira Ogawa ◽  
Motonobu Kameyama ◽  
Kenji Muraishi ◽  
Takashi Yoshimoto ◽  
Masatoshi Ito ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
Occlusive Disease ◽  
Oxygen Extraction Fraction ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery

✓ In order to clarify the effectiveness of extracranial-intracranial bypass operations in patients with vertebrobasilar occlusive disease, the authors used positron emission tomography to investigate the cerebral blood flow (CBF) and metabolism of eight patients undergoing superficial temporal artery (STA)-superior cerebellar artery (SCA) bypass procedures. In the preoperative studies, CBF in the region of the posterior fossa was low and the oxygen extraction fraction (OEF) was high, the so-called “misery perfusion syndrome.” Such changes were evident in both the posterior circulation and the anterior circulation regions. Postoperatively, there was a significant increase in CBF, a significant decrease in the OEF not only in the region of posterior circulation but also over the entire brain, and a disappearance of the uncoupling between CBF and oxygen metabolism. The STA-SCA bypass procedure is effective in improving CBF and metabolism in patients with vertebrobasilar occlusive disease.

Superficial Temporal Artery–Superior Cerebellar Artery Bypass with Anterior Petrosectomy

2018 ◽  
Vol 114 ◽  
pp. 179-186
Author(s):  
Masaaki Hokari ◽  
Katsuyuki Asaoka ◽  
Daisuke Shimbo ◽  
Kazuki Uchida ◽  
Koji Itamoto
Keyword(s):  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Anterior Petrosectomy

scholarly journals Superficial temporal artery-superior cerebellar artery bypass and direct clipping of a large unruptured superior cerebellar artery aneurysm through subtemporal approach: Surgical video

2019 ◽  
Vol 10 ◽  
pp. 225
Author(s):  
Jiangyu Xue ◽  
Hugo Andrade-Barazarte ◽  
Gangqin Xu ◽  
Dongyang Cai ◽  
Yang Bowen ◽  
...  
Keyword(s):  
Blood Flow ◽  
Surgical Treatment ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Subtemporal Approach ◽  
Cerebellar Artery

Background: Superior cerebellar artery (SCA) aneurysms are rare. Current treatments include: direct clipping, trapping ± bypass, and endovascular methods (coiling, stenting, or flow diversion). Due to specific characteristics (wide base, location, and shape), a major challenge while dealing with SCA aneurysms is to preserve the flow of the parent artery and perforators. This video demonstrates a revascularization procedure, and clip reconstruction of a large unruptured basilar artery (BA)/SCA aneurysm performed through the subtemporal approach. Case Description: A 60-year-old woman presented with dizziness and headaches. Computed tomography angiography (CTA) and digital subtraction angiography showed a right unruptured large BA/SCA aneurysm. After multidisciplinary discussion, and considering gender, age, risk factors of the patient. Endovascular treatment was considered with a high risk of ischemic complications. Therefore, the patient was consented for a superficial temporal artery (STA)-SCA bypass through subtemporal approach followed by direct clipping/ trapping of the aneurysm. Postoperative CTA showed occlusion of the aneurysm and patency of the parent vessels. Postoperatively, the patient experienced immediate transient left mild monoparesis and right IV nerve palsy, which recovered completely at 6-months follow-up. Results: Surgical treatment of SCA aneurysms is decreasing due to the existence of endovascular therapies such as stents and flow diverters. However, some cases may necessitate surgical treatment and revascularization procedures to maintain the blood flow of the parent artery and to treat the previous lesion. Conclusion: The STA-SCA bypass through the subtemporal approach is a feasible option to maintain the blood flow of the parent artery in cases of SCA requiring surgical treatment and trapping/direct clipping of the aneurysm.

Intracranial Vertebral Endarterectomy

Neurosurgery ◽  
1990 ◽  
Vol 26 (3) ◽  
pp. 465-471 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Balaji Sadasivan ◽  
Manuel Dujovny
Keyword(s):  
Vertebral Artery ◽  
Medical Therapy ◽  
Superficial Temporal Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Focal Lesion ◽  
Cerebellar Infarction ◽  
Vertebrobasilar Insufficiency ◽  
Cerebellar Artery

Abstract Intracranial vertebral endarterectomy was performed on six patients with vertebrobasilar insufficiency in whom medical therapy failed. The patients underwent operations for stenotic plaque in the intracranial vertebral artery with the opposite vertebral artery being occluded, hypoplastic, or severely stenosed. In four of the patients, the stenosis was mainly proximal to the posterior inferior cerebellar artery (PICA). In this group, after endarterectomy, the vertebral artery was patent in two patients, and their symptoms resolved: in one patient the endarterectomy occluded, but the patient's symptoms improved; and in one patient the endarterectomy was unsuccessful, and he continued to have symptoms. In one patient, the plaque was at the origin of the PICA. The operation appeared technically to be successful, but the patient developed a cerebellar infarction and died. In one patient the stenosis was distal to the PICA. During endarterectomy, the plaque was found to invade the posterior wall of the vertebral artery. The vertebral artery was ligated, and the patient developed a Wallenburg syndrome. The results of superficial temporal artery to superior cerebellar artery anastomosis are better than those for intracranial vertebral endarterectomy for patients with symptomatic intracranial vertebral artery stenosis. The use of intracranial vertebral endarterectomy should be limited to patients who have disabling symptoms despite medical therapy, a focal lesion proximal to the PICA, and a patent posterior circulation collateral or bypass.

Sign in / Sign up

Export Citation Format

Share Document