Touho H, Karasawa J, Ohnishi H, Kobitsu K
Department of Neurosurgery, Osaka Neurological Institute, Japan.
Surg Neurol. 1995 Sep;44(3):245-9; discussion 249-50. doi: 10.1016/0090-3019(95)00052-6.
Superficial temporal artery (STA)-superior cerebellar artery (SCA) anastomosis, and STA-posterior cerebral artery (PCA) anastomosis are considered suitable as surgical procedures for the treatment of patients with significant stenosis or occlusion in the rostral portion of the basilar artery and patients with significant stenosis or occlusion of the posterior cerebral artery, respectively. However, several authors have reported frequent and serious complications of these surgical procedures, including temporal lobe retraction edema and hematoma. In this study, we introduce a new surgical revascularization using an occipital interhemispheric transtentorial approach for the treatment of severe stenosis of the rostral portion of the basilar artery.
A 47-year-old man with hypertension noted the sudden onset of nuchal pain followed by vertigo, diplopia, drunken gait, and motor weakness on his right side. Angiography performed on the day of the onset disclosed severe stenosis of the basilar artery. The stenotic portion extended just distal to the anterior-inferior cerebellar artery (AICA) to just proximal to the SCA, and in addition, a pseudolumen was visualized just distal to the left AICA. The patient underwent right occipital artery (OA) to left PCA anastomosis with interposition of the STA using an occipital interhemispheric transtentorial approach. Marked improvement in dysarthria, diplopia, ataxia gait, and visual disturbance were noted and he was able to walk without aid 3 days after operation. A postoperative angiogram of the right OA obtained 25 days after operation demonstrated visualization of the left PCA via the anastomosed OA and STA graft.
OA-PCA anastomosis with interposition of STA graft using an occipital interhemispheric transtentorial approach can be substituted for STA-SCA anastomosis and STA-PCA anastomosis for treatment of stenosis/occlusion of the rostral portion of the basilar artery.
颞浅动脉（STA）-小脑上动脉（SCA）吻合术以及STA-大脑后动脉（PCA）吻合术，分别被认为是治疗基底动脉起始部严重狭窄或闭塞患者以及大脑后动脉严重狭窄或闭塞患者的合适手术方法。然而，有几位作者报告了这些手术常见且严重的并发症，包括颞叶牵拉性水肿和血肿。在本研究中，我们介绍一种用于治疗基底动脉起始部严重狭窄的枕叶半球间经小脑幕入路的新型手术血管重建方法。
一名47岁患有高血压的男性，突然出现颈部疼痛，随后出现眩晕、复视、醉酒步态以及右侧肢体运动无力。发病当天进行的血管造影显示基底动脉严重狭窄。狭窄部分从前下小脑动脉（AICA）远端延伸至SCA近端，此外，在左侧AICA远端可见一个假腔。患者采用枕叶半球间经小脑幕入路，行右侧枕动脉（OA）与左侧PCA吻合，并植入STA。术后言语不清、复视、共济失调步态和视觉障碍明显改善，术后3天患者能够独立行走。术后25天获得的右侧OA术后血管造影显示，通过吻合的OA和STA移植物可使左侧PCA显影。
采用枕叶半球间经小脑幕入路，植入STA移植物行OA-PCA吻合术，可替代STA-SCA吻合术和STA-PCA吻合术治疗基底动脉起始部狭窄/闭塞。
