Sanada Y, Kamiyama H, Iwaisako K, Yoshimine T, Kato A
Department of Neurosurgery, Kinki University Medical School, 377-2 Ohno-Higashi, Osaka-Sayama, Japan.
Minim Invasive Neurosurg. 2010 Aug;53(4):203-6. doi: 10.1055/s-0030-1263109. Epub 2010 Dec 3.
Anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA) is useful for treating certain patients with internal carotid artery occlusion or MCA occlusion. However, in the case of common carotid artery (CCA) occlusion, since the blood flow in the STA is insufficient, another artery should be used as the donor artery. The cortical branches of the MCA are usually selected as recipients in the STA-MCA bypass. However, the intracranial vascular filling gradually increases over a few months after conventional cortical MCA bypass grafting, while early or even immediate vascular filling is observed after proximal MCA bypass grafting. This study aims to develop an elongation technique of the contralateral STA to reach the proximal segment of the ipsilateral MCA.
Anastomosis of the contralateral STA to the secondary trunk of the ipsilateral MCA was performed in 2 patients with occlusion of the CCA and ipsilateral vertebral artery (VA). The contralateral STA was extended with a radial artery (RA) graft in order to supply blood to the ischemic area. Elongation of the STA by using an RA interposition graft sufficiently lengthens the graft to enable its anastomosis with the contralateral M2 segment. Postoperative imaging revealed good bypass patency even at 1 year after the surgery.
This novel technique of performing the "bonnet" bypass was effective in treating both CCA and ipsilateral VA occlusion; moreover, this procedure of elongation of the STA can increase candidates of the recipient, and enables one to perform a double bypass to the anterior cerebral artery (ACA) or posterior cerebral artery (PCA).
颞浅动脉（STA）与大脑中动脉（MCA）吻合术对治疗某些颈内动脉闭塞或MCA闭塞患者有用。然而，在颈总动脉（CCA）闭塞的情况下，由于STA中的血流不足，应使用另一动脉作为供体动脉。在STA-MCA搭桥术中，通常选择MCA的皮质支作为受体。然而，传统的皮质MCA搭桥术后几个月内颅内血管充盈逐渐增加，而近端MCA搭桥术后则观察到早期甚至即刻血管充盈。本研究旨在开发一种对侧STA的延长技术，以到达同侧MCA的近端段。
对2例CCA和同侧椎动脉（VA）闭塞患者进行对侧STA与同侧MCA二级主干的吻合。用桡动脉（RA）移植物延长对侧STA，以便向缺血区域供血。使用RA插入移植物延长STA可充分延长移植物，使其能够与对侧M2段吻合。术后影像学检查显示，即使在术后1年，搭桥通畅情况良好。
这种进行“帽状”搭桥的新技术在治疗CCA和同侧VA闭塞方面有效；此外，这种STA延长手术可以增加受体的选择，并使人们能够对大脑前动脉（ACA）或大脑后动脉（PCA）进行双搭桥。
