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Superficial temporal artery to middle cerebral artery anastomosis for neovascular glaucoma due to common carotid artery occlusion.

Yamamoto S, Kashiwazaki D, Akioka N, Kuwayama N, Kuroda S - Surg Neurol Int (2015)

Bottom Line: His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma.Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery.His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.

ABSTRACT

Background: Common carotid artery (CCA) occlusion sometimes requires surgical revascularization to resolve persistent cerebral/ocular ischemia. High-flow bypass is often indicated in these cases, using the interposed graft such as saphenous vein and radial artery. However, high-flow bypass surgery is invasive and may provide excessive blood flow to ischemic brain. In this report, we present a case that developed neovascular glaucoma due to CCA occlusion and was successfully treated with superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis.

Case description: A 61-year-old male complained of left visual disturbance and was admitted to our hospital. He underwent carotid endarterectomy for left internal carotid artery stenosis in previous hospital 1-year before, but he experienced left visual disturbance after surgery. Postoperative examinations revealed that the CCA was occluded. His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma. None of ophthalmological therapy could improve his symptoms. Blood flow measurement showed an impaired reactivity to acetazolamide in the left cerebral hemisphere. Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery. Therefore, he successfully underwent left STA-MCA double anastomosis. His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

Conclusions: Precise radiological examination may enable standard STA-MCA anastomosis even in patients with CCA occlusion.

No MeSH data available.


Related in: MedlinePlus

Postoperative single photon emission computed tomography findings of cerebral blood flow before (a) and after intravenous injection of acetazolamide. (b) Note that the reactivity to acetazolamide completely recovered in the left middle cerebral artery territory
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Figure 4: Postoperative single photon emission computed tomography findings of cerebral blood flow before (a) and after intravenous injection of acetazolamide. (b) Note that the reactivity to acetazolamide completely recovered in the left middle cerebral artery territory

Mentions: Based on these findings, he underwent left STA-MCA double anastomosis to resolve the reversed blood flow in the left ophthalmic artery and improve his glaucoma-related symptoms. The frontal and parietal branches of the STA were carefully dissected under a surgical microscope. We could confirm that the blood flow from the distal end of the ipsilateral STA had enough high-pressure during surgery. The branches of STA were anastomosed to the frontal and temporal branches of the MCA with an end-to-side fashion, respectively. The patency was confirmed during surgery, using indocyanine green videoangiography. Postoperative course was uneventful. Postoperative SPECT study performed 2 weeks after surgery demonstrated that the reactivity to acetazolamide completely recovered in the territory of the left MCA [Figure 4]. Postoperative cerebral angiography demonstrated that STA-MCA anastomosis supplied enough blood flow to the operated hemisphere [Figure 5]. Follow-up ultrasound examination also revealed that the reversed blood flow in the left ophthalmic artery improved from −40 cm/s to −20 cm/s at 6 days after surgery [Figure 3]. His visual disturbance did not deteriorate for these 21 months after surgery. Abnormal blood vessels around the iris gradually decreased and disappeared. Intraocular pressure decreased from 38 to 16 mmHg.


Superficial temporal artery to middle cerebral artery anastomosis for neovascular glaucoma due to common carotid artery occlusion.

Yamamoto S, Kashiwazaki D, Akioka N, Kuwayama N, Kuroda S - Surg Neurol Int (2015)

Postoperative single photon emission computed tomography findings of cerebral blood flow before (a) and after intravenous injection of acetazolamide. (b) Note that the reactivity to acetazolamide completely recovered in the left middle cerebral artery territory
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496833&req=5

Figure 4: Postoperative single photon emission computed tomography findings of cerebral blood flow before (a) and after intravenous injection of acetazolamide. (b) Note that the reactivity to acetazolamide completely recovered in the left middle cerebral artery territory
Mentions: Based on these findings, he underwent left STA-MCA double anastomosis to resolve the reversed blood flow in the left ophthalmic artery and improve his glaucoma-related symptoms. The frontal and parietal branches of the STA were carefully dissected under a surgical microscope. We could confirm that the blood flow from the distal end of the ipsilateral STA had enough high-pressure during surgery. The branches of STA were anastomosed to the frontal and temporal branches of the MCA with an end-to-side fashion, respectively. The patency was confirmed during surgery, using indocyanine green videoangiography. Postoperative course was uneventful. Postoperative SPECT study performed 2 weeks after surgery demonstrated that the reactivity to acetazolamide completely recovered in the territory of the left MCA [Figure 4]. Postoperative cerebral angiography demonstrated that STA-MCA anastomosis supplied enough blood flow to the operated hemisphere [Figure 5]. Follow-up ultrasound examination also revealed that the reversed blood flow in the left ophthalmic artery improved from −40 cm/s to −20 cm/s at 6 days after surgery [Figure 3]. His visual disturbance did not deteriorate for these 21 months after surgery. Abnormal blood vessels around the iris gradually decreased and disappeared. Intraocular pressure decreased from 38 to 16 mmHg.

Bottom Line: His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma.Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery.His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.

ABSTRACT

Background: Common carotid artery (CCA) occlusion sometimes requires surgical revascularization to resolve persistent cerebral/ocular ischemia. High-flow bypass is often indicated in these cases, using the interposed graft such as saphenous vein and radial artery. However, high-flow bypass surgery is invasive and may provide excessive blood flow to ischemic brain. In this report, we present a case that developed neovascular glaucoma due to CCA occlusion and was successfully treated with superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis.

Case description: A 61-year-old male complained of left visual disturbance and was admitted to our hospital. He underwent carotid endarterectomy for left internal carotid artery stenosis in previous hospital 1-year before, but he experienced left visual disturbance after surgery. Postoperative examinations revealed that the CCA was occluded. His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma. None of ophthalmological therapy could improve his symptoms. Blood flow measurement showed an impaired reactivity to acetazolamide in the left cerebral hemisphere. Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery. Therefore, he successfully underwent left STA-MCA double anastomosis. His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.

Conclusions: Precise radiological examination may enable standard STA-MCA anastomosis even in patients with CCA occlusion.

No MeSH data available.


Related in: MedlinePlus