Department of Neurosurgery, Kumamoto University School of Medicine, Honjo, Kumamoto, Japan.
Department of Neurosurgery, Saiseikai Kumamoto Hospital, Chikami, Kumamoto, Japan.
World Neurosurg. 2019 Jul;127:e864-e872. doi: 10.1016/j.wneu.2019.03.287. Epub 2019 Apr 4.
The superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis (STA-MCA bypass) currently is performed to prevent atherosclerotic occlusive cerebrovascular disease. However, the benefits of the bypass surgery remain controversial. To ensure consistent surgical benefits, understanding the mechanisms of perioperative cerebral infarction (CI) is required. Moreover, appropriate patient selection procedures must be determined to decrease the rate of perioperative stroke. We retrospectively investigated patients who underwent bypass surgery at our institution and determined that the patients who presented with cortical venous reddening after anastomosis during the surgery developed perioperative CI.
A total of 45 consecutive patients who underwent bypass surgery were retrospectively investigated. Twenty-five of the 45 patients underwent bypass for atherosclerotic occlusion or stenosis of the internal carotid artery or middle cerebral artery. Preoperative iodine-123-N-isopropyl-iodoamphetamine single-photon emission computed tomography was performed with and without acetazolamide administration. Change in color of the cortical veins was observed on recorded surgical videos, and its correlation with perioperative CI was investigated.
We experienced 2 cases of perioperative extensive CI at a region remote from the site of anastomosis. In both cases, retrospective investigation of surgical videos demonstrated reddening of cortical veins soon after the anastomosis procedure. Of all 45 patients, postoperative CI and venous reddening were observed in only these 2 cases.
We determined that patients presenting with cortical venous reddening after anastomosis developed perioperative CI. Cortical venous reddening may be an important predictor for the occurrence of CI after STA-MCA bypass surgery for patients with atherosclerotic occlusive cerebrovascular disease.
目前，颞浅动脉（STA）-大脑中动脉（MCA）吻合术（STA-MCA 旁路）用于预防动脉粥样硬化性闭塞性脑血管病。然而，旁路手术的益处仍存在争议。为了确保一致的手术获益，需要了解围手术期脑梗死（CI）的机制。此外，必须确定适当的患者选择程序，以降低围手术期卒中的发生率。我们回顾性调查了在我院接受旁路手术的患者，发现吻合术后出现皮质静脉变红的患者发生了围手术期 CI。
回顾性调查了 45 例连续接受旁路手术的患者。45 例患者中有 25 例行旁路手术治疗颈内动脉或大脑中动脉粥样硬化性闭塞或狭窄。在不使用和使用乙酰唑胺的情况下，对碘-123-N-异丙基-碘胺单光子发射计算机断层扫描进行了术前检查。观察记录手术视频中皮质静脉颜色的变化，并研究其与围手术期 CI 的相关性。
我们在远离吻合部位的区域经历了 2 例围手术期广泛 CI。在这两种情况下，对手术视频的回顾性调查表明，吻合术后不久皮质静脉出现变红。在所有 45 例患者中，仅在这 2 例患者中观察到术后 CI 和静脉变红。
我们发现吻合术后出现皮质静脉变红的患者发生了围手术期 CI。皮质静脉变红可能是预测动脉粥样硬化性闭塞性脑血管病患者行 STA-MCA 旁路手术后发生 CI 的重要指标。
