Chung Yeongu, Lee Sung Ho, Ryu Jiwook, Kim Johnho, Chung Sang Bong, Choi Seok Keun
Department of Neurosurgery, College of Medicine, Kyung Hee University, Kyung Hee University Hospital, Seoul, South Korea.
Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea.
World Neurosurg. 2017 May;101:813.e5-813.e9. doi: 10.1016/j.wneu.2017.03.043. Epub 2017 Mar 18.
This report describes the need for a tailored approach for intracranial vascular occlusive disease and introduces the usefulness of the OA as a donor artery for interposition graft.
A 65-year-old male patient suffered from repeated transient ischemic attack (TIA). Imaging studies revealed complete occlusion of the proximal left side of the internal carotid artery (ICA) and multiple infarction in the watershed zone. We planned superficial temporal artery-middle cerebral artery (STA-MCA) bypass to restore cerebral blood flow and to prevent the progression of infarction. However, the parietal branch of the STA was too small in diameter and not suitable as a single donor for the bypass in order to supply sufficient blood flow. Moreover, the frontal branch of the STA had collateral channels through the periorbital anastomosis into the cerebral cortex that could result in infarction during clamping for anastomosis.
We determined that tailored treatment planning was necessary for successful revascularization under these conditions. Thus, we performed a bypass between the parietal branch of the STA and a cortical branch of the MCA as an "insurance bypass." Then we performed another bypass between the frontal branch of the STA and a cortical branch of the MCA using an ipsilateral occipital artery (OA) interposition graft. The patient had no perioperative complications, and postoperative imaging confirmed the restoration of cerebral blood flow.
When end-to-side anastomosis in single-branch bypass is not appropriate for cerebral revascularization, a tailored double-barrel "insurance bypass" with an OA interposed graft could be a good alternative treatment modality. In addition, an OA interposition graft is a useful option for double-barrel bypass surgery in such cases of intracranial vascular occlusive disease.
本报告描述了针对颅内血管闭塞性疾病采用定制化方法的必要性，并介绍了枕动脉作为移植搭桥供体动脉的实用性。
一名65岁男性患者反复出现短暂性脑缺血发作（TIA）。影像学检查显示左侧颈内动脉（ICA）近端完全闭塞，分水岭区多发梗死。我们计划行颞浅动脉-大脑中动脉（STA-MCA）搭桥术以恢复脑血流并预防梗死进展。然而，STA的顶支直径过小，不适合作为单一搭桥供体以提供足够的血流。此外，STA的额支通过眶周吻合形成侧支通道进入大脑皮层，在吻合时夹闭可能导致梗死。
我们确定在这些情况下，为成功实现血管重建，定制化治疗方案是必要的。因此，我们在STA的顶支与MCA的一个皮质支之间进行了搭桥，作为“保险搭桥”。然后我们使用同侧枕动脉（OA）移植在STA的额支与MCA的一个皮质支之间进行了另一搭桥。患者无围手术期并发症，术后影像学检查证实脑血流恢复。
当单支搭桥的端侧吻合不适用于脑血运重建时，采用带OA移植的定制双管“保险搭桥”可能是一种良好的替代治疗方式。此外，在颅内血管闭塞性疾病的此类病例中，OA移植是双管搭桥手术的一个有用选择。
