Cerebral revascularization to a main limb of the middle cerebral artery in the Sylvian fissure. An alternative approach to conventional anastomosis.

Abstract:

:Thirteen patients underwent an anastomosis of the superficial temporal artery (STA) or a saphenous vein graft to one of the secondary trunks of the middle cerebral artery (MCA). They included five patients with giant MCA trifurcation aneurysms, four patients in whom an earlier conventional STA-MCA anastomosis had become occluded, two patients who had stenosis of one of the secondary limbs of the MCA, and one patient who had a carotid-cavernous fistula. One patient had a saphenous vein graft from the common carotid artery to a secondary trunk of the MCA to bypass an occluded internal carotid artery and severely stenosed external carotid artery. The primary advantages of this procedure are that a large-caliber anastomosis to one of the secondary limbs of the MCA immediately restores flow into the MCA tree with a larger amount of vessel filling than with a standard cortical bypass, and large vessels can be used for the anastomosis. The disadvantages are that one of the secondary branches of the MCA must be occluded, the cerebral hemisphere around the Sylvian fissure must be retracted, a lumbar subarachnoid drain is needed, and the anastomosis must be performed deep within the Sylvian fissure. The procedure is a satisfactory alternative in cases in which a conventional STA-MCA anastomosis has either failed or would be less likely to succeed.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Diaz FG,Umansky F,Mehta B,Montoya S,Dujovny M,Ausman JI,Cabezudo J

doi

10.3171/jns.1985.63.1.0021

subject

Has Abstract

pub_date

1985-07-01 00:00:00

pages

21-9

issue

1

eissn

0022-3085

issn

1933-0693

journal_volume

63

pub_type

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