Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan.
Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan.
World Neurosurg. 2021 Feb;146:e452-e460. doi: 10.1016/j.wneu.2020.10.114. Epub 2020 Oct 24.
To investigate long-term bypass patency and final structure for patients who underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass.
This study retrospectively evaluated 20 patients who underwent STA-MCA bypass and had 2-year follow-up with cerebral angiography. Patients were divided into internal carotid artery occlusion (n = 11) and MCA occlusion or stenosis (n = 9) groups, and diagnosis was either arteriosclerotic (n = 14) or nonarteriosclerotic (n = 6) disease. Final bypass formation was examined with cerebral angiography at 2 years postoperatively. Diameters of the STA, middle meningeal artery (MMA), and deep temporal artery (DTA) were measured at preoperative angiography and at 2-year follow-up.
No significant differences in STA, MMA, and DTA diameters were reported between the internal carotid artery versus MCA group. For patients with arteriosclerotic disease, thicker STA diameters were noted on preoperative angiography. For patients with nonarteriosclerotic disease, MMA and DTA dilatation was noted on 2-year follow-up imaging. For patients with arteriosclerotic disease, all direct bypasses were patent at 2 years. For patients with nonarteriosclerotic disease, remarkable angiogenesis was demonstrated.
Long-term patency of a direct bypass may be correlated with arteriosclerotic or nonarteriosclerotic etiology. An indirect bypass route may develop in patients with nonarteriosclerotic disease; therefore, it is important to create a foundation for an indirect bypass with MMA and DTA preservation during craniotomy. In 2 patients with nonarteriosclerotic disease, STA remained the primary bypass foundation; however, the technique resembled novel angiogenesis after encephaloduroarteriosynangiosis and not direct STA-MCA bypass. Therefore, final bypass structure might be affected by disease etiology.
研究接受颞浅动脉（STA）-大脑中动脉（MCA）旁路术患者的长期旁路通畅率和最终结构。
本研究回顾性评估了 20 例接受 STA-MCA 旁路术并在 2 年内进行了脑血管造影随访的患者。患者分为颈内动脉闭塞组（n=11）和 MCA 闭塞或狭窄组（n=9），诊断为动脉粥样硬化性（n=14）或非动脉粥样硬化性（n=6）疾病。术后 2 年通过脑血管造影检查最终旁路形成情况。术前和术后 2 年分别测量 STA、脑膜中动脉（MMA）和颞深动脉（DTA）的直径。
颈内动脉与 MCA 组之间 STA、MMA 和 DTA 直径无显著差异。对于动脉粥样硬化性疾病患者，术前血管造影显示 STA 直径较厚。对于非动脉粥样硬化性疾病患者，在 2 年随访时观察到 MMA 和 DTA 扩张。对于动脉粥样硬化性疾病患者，所有直接旁路均在 2 年内保持通畅。对于非动脉粥样硬化性疾病患者，明显的血管生成。
直接旁路的长期通畅性可能与动脉粥样硬化或非动脉粥样硬化病因有关。非动脉粥样硬化性疾病患者可能会形成间接旁路；因此，在开颅手术中保护 MMA 和 DTA 以建立间接旁路的基础非常重要。在 2 例非动脉粥样硬化性疾病患者中，STA 仍然是主要的旁路基础；然而，该技术类似于硬脑膜脑动脉吻合术后的新血管生成，而不是直接 STA-MCA 旁路。因此，最终旁路结构可能受到疾病病因的影响。
