Abstract：
BACKGROUND:Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is associated with a relatively high risk of surgical complications, such as hematoma and/or edema caused by temporal lobe retraction. Therefore, the right side is typically used to avoid retraction of the left temporal lobe. In this report, we present a case of left STA-SCA bypass with anterior petrosectomy to avoid retraction of dominant-side temporal lobe and describe the surgical technique in detail. CASE DESCRIPTION:A 69-year-old man presented with gradual worsening of dysarthria and gait disturbance. Magnetic resonance imaging showed no signs of acute infarction, but digital subtraction angiography showed severe stenosis of basilar artery and faint flow in the distal basilar artery. On 3-dimensional computed tomography angiography, posterior communicating arteries were not visualized; we could identify the left SCA, but not the right SCA. Despite dual antiplatelet therapy, a small fresh brainstem infarct was detected 10 days after admission. To avert fatal brainstem infarction and further enlargement of the infarct, we performed left STA-SCA bypass with anterior petrosectomy to avoid retraction of the dominant-side temporal lobe. Postoperative imaging revealed no new lesions, such as infarction or temporal lobe contusional hematoma, and confirmed the patency of the bypass. Postoperative single-photon emission computed tomography demonstrated improved cerebral blood flow in the posterior circulation. The patient was transferred to another hospital for rehabilitation. CONCLUSIONS:This method helps minimize the risk of injury to the temporal lobe, especially that of the dominant side.
journal_name
World Neurosurgjournal_title
World neurosurgeryauthors
Hokari M,Asaoka K,Shimbo D,Uchida K,Itamoto Kdoi
10.1016/j.wneu.2018.03.118subject
Has Abstractpub_date
2018-06-01 00:00:00pages
179-186eissn
1878-8750issn
1878-8769pii
S1878-8750(18)30600-4journal_volume
114pub_type
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