Manabe T, Kikuchi H, Furuse S, Karasawa J, Sakaki T
No Shinkei Geka. 1977 Apr;5(4):355-61.
Case 1. A 65 year old male had left hemiparesis with sudden onset since 8 years ago, which gradually aggravated for these 2 years. On Sept. 27, 1973, he was admitted to the Department of Neurosurgery, Kitano Hospital. There was left spastic hemiparesis with hemisensory disturbance and he could not walk without help for the maked spasticity. Left carotid angiogram revealed the complete occlusion of the internal carotid artery and marked stenosis of the external carotid artery at the common carotid bifurcation. External carotid endarterectomy was performed on Nov. 19, 1973, which was followed by STA-MCA anastomosis 2 months later. The spasticity of extremities and left hemisparesis were gradually improved and he was able to walk without help. Case 2. On Apr. 14, 1974, a 63 year old female developed complete stroke with right hemiparesis and speech disturbance after transient ischemic attacks of 5 days duration. On Aug. 9, he was admitted and had emotional incontinence, right hemiparesis, Gerstmann's syndrome and motor aphasia. Left carotid angiogram revealed a saccular aneurysm of the middle cerebral artery and the occlusion of the distal middle cerebral arterys. These findings suggested that the occlusion was caused by embolus from the middle cerebral aneurysm, and the combined surgery with STA-MCA anastomosis and operation for the aneurysm was planned. On Aug. 30, 1974, under left frontotemporal craniotomy, aneurysmal neck clipping and aneurysmectomy were performed and thereafter, STA-MCA double anastomosis was done. One week after operation, the gradual improvement of pre-operative symptomes was noted. Recently, STA-MCA anatomosis is well known to be one of the effective operative methods for the occlusive methods for the occlusive cerebrovascular diseases and in addition, we found that the combination of STA-MCA anastomosis with other operations was effective for unusual cases presenting in this report. Furthermore, except for the occlusive cerebrovascular diseases, we usually plan STA-MCA anastomosis for the cases of 1) carotid ligation or trapping for carotid-cavernous sinus fistula and some internal carotid aneurysms, 2) some intracranial tumors with the danger involving the main cerebral arteries by operation to protect the cerebrovascular insufficiency.
病例1。一名65岁男性自8年前起突发左侧偏瘫，近2年逐渐加重。1973年9月27日，他入住北野医院神经外科。存在左侧痉挛性偏瘫伴偏身感觉障碍，因严重痉挛，他无法独立行走。左侧颈动脉血管造影显示颈内动脉完全闭塞，颈总动脉分叉处颈外动脉明显狭窄。1973年11月19日进行了颈外动脉内膜切除术，2个月后进行了颞浅动脉-大脑中动脉吻合术。肢体痉挛和左侧偏瘫逐渐改善，他能够独立行走。病例2。1974年4月14日，一名63岁女性在持续5天的短暂性脑缺血发作后发生完全性中风，出现右侧偏瘫和言语障碍。8月9日入院，存在情感失禁、右侧偏瘫、格斯特曼综合征和运动性失语。左侧颈动脉血管造影显示大脑中动脉囊状动脉瘤及大脑中动脉远端闭塞。这些发现提示闭塞是由大脑中动脉瘤的栓子引起的，计划进行颞浅动脉-大脑中动脉吻合术与动脉瘤手术联合治疗。1974年8月30日，在左侧额颞开颅手术下，进行了动脉瘤颈夹闭和动脉瘤切除术，随后进行了颞浅动脉-大脑中动脉双吻合术。术后一周，术前症状逐渐改善。最近，颞浅动脉-大脑中动脉吻合术是治疗闭塞性脑血管疾病的有效手术方法之一，此外，我们发现颞浅动脉-大脑中动脉吻合术与其他手术联合应用对本报告中出现的特殊病例有效。此外，除了闭塞性脑血管疾病外，对于以下情况我们通常计划进行颞浅动脉-大脑中动脉吻合术：1）颈动脉结扎或圈套术治疗颈动脉海绵窦瘘和一些颈内动脉瘤；2）一些颅内肿瘤手术时可能累及主要脑动脉，为预防脑血管供血不足。
