S Nagasawa1, I Sakaguchi, T Ohta. 1. Department of Neurosurgery, Osaka Medical College, Takatsuki-City, Japan.
Abstract
BACKGROUND: While superficial temporal artery (STA) to superior cerebellar artery (SCA) or STA to posterior cerebral artery (PCA) anastomosis has been used for rostral brain stem ischemia, it is reported not infrequently to be associated with serious complications. Although the inferior temporal artery has been proposed as a possible recipient artery for the STA, its advantage is not yet widely recognized. CASE REPORT: A 42-year-old man presented with repeated loss of vision in the left visual field. Angiography disclosed occlusion in the proximal portion of the P2 segment of the right PCA. The second case was a 68-year-old man experiencing swallowing disturbance; the bilateral vertebral arteries were markedly stenotic. Since hemodynamic insufficiency was considered to be responsible for the patients' symptoms, STA-PCA anastomosis was performed using the posterior temporal artery (PTA) as the recipient. The postoperative courses were uneventful with good patency of the bypass. TECHNIQUE: Through a horizontally extended temporal craniotomy with the base of the temporal bone sufficiently drilled away, the inferior aspect of the temporal lobe was searched for a recipient artery for the STA. The anastomosis was performed with less difficulty and at a shallower level, by 20 mm in one case and by 10 mm in the other, than had we anastomosed it to the P2 segment of the PCA. CONCLUSION: Anastomosis of the STA to the PTA is less complicated than anastomosis of the STA to the main branch of the PCA for the treatment of rostral brain stem ischemia.
BACKGROUND: While superficial temporal artery (STA) to superior cerebellar artery (SCA) or STA to posterior cerebral artery (PCA) anastomosis has been used for rostral brain stem ischemia, it is reported not infrequently to be associated with serious complications. Although the inferior temporal artery has been proposed as a possible recipient artery for the STA, its advantage is not yet widely recognized. CASE REPORT: A 42-year-old man presented with repeated loss of vision in the left visual field. Angiography disclosed occlusion in the proximal portion of the P2 segment of the right PCA. The second case was a 68-year-old man experiencing swallowing disturbance; the bilateral vertebral arteries were markedly stenotic. Since hemodynamic insufficiency was considered to be responsible for the patients' symptoms, STA-PCA anastomosis was performed using the posterior temporal artery (PTA) as the recipient. The postoperative courses were uneventful with good patency of the bypass. TECHNIQUE: Through a horizontally extended temporal craniotomy with the base of the temporal bone sufficiently drilled away, the inferior aspect of the temporal lobe was searched for a recipient artery for the STA. The anastomosis was performed with less difficulty and at a shallower level, by 20 mm in one case and by 10 mm in the other, than had we anastomosed it to the P2 segment of the PCA. CONCLUSION: Anastomosis of the STA to the PTA is less complicated than anastomosis of the STA to the main branch of the PCA for the treatment of rostral brain stem ischemia.