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Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Muta D, Kawano T, Shinojima N, Kuratsu J - Springerplus (2015)

Bottom Line: Ischemic events are the main clinical manifestation of this condition.Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses.To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjyo, Chuoku, Kumamoto, 8608556 Japan.

ABSTRACT
Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy is a rare hereditary small vessel disease. Ischemic events are the main clinical manifestation of this condition. Here, we present a case in which superficial temporal artery-to-middle cerebral artery anastomosis was performed in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who developed cerebral infarctions caused by severe middle cerebral artery stenosis. Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses. To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature. Superficial temporal artery-to-middle cerebral artery anastomosis is effective for patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who show marked regional cerebral hypoperfusion.

No MeSH data available.


Related in: MedlinePlus

Postoperative MRI shows no remarkable change on abnormal intensity in the anterior temporal lobe (a), external capsules, periventricular regions (b), and white matter (c). MR angiography revealed the patency of the right STA-MCA double anastomoses (d)
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Fig5: Postoperative MRI shows no remarkable change on abnormal intensity in the anterior temporal lobe (a), external capsules, periventricular regions (b), and white matter (c). MR angiography revealed the patency of the right STA-MCA double anastomoses (d)

Mentions: The post-operative course was uneventful. On post-operative day 1, an IMP-SPECT study showed a 50 % increase in uptake in the right MCA territory but not hyperperfusion, and MRI demonstrated the patency of the double anastomosis (data not shown). IMP-SPECT images obtained 1 month after surgery showed improved regional CBF (Fig. 4c) and CVR (Fig. 4d) in the right hemisphere. No hemorrhagic complications occurred. After surgery, the patient’s preoperative symptoms were relieved, and the TIAs disappeared. The patient was discharged 12 days after surgery. Sixteen months have already passed since surgery, and the patient is doing well. Cerebrovascular events such as TIA, infarction and hemorrhage have not appeared. Follow up MRI 14 months after surgery showed no remarkable area of increased intensity indicating white matter abnormalities in the left anterior temporal lobe, both anterior frontal lobes, external capsules, or periventricular regions on FLAIR images (Fig. 5a–c). MR angiography was used to confirm the patency of the bypass (Fig. 5d).Fig. 5


Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Muta D, Kawano T, Shinojima N, Kuratsu J - Springerplus (2015)

Postoperative MRI shows no remarkable change on abnormal intensity in the anterior temporal lobe (a), external capsules, periventricular regions (b), and white matter (c). MR angiography revealed the patency of the right STA-MCA double anastomoses (d)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4628037&req=5

Fig5: Postoperative MRI shows no remarkable change on abnormal intensity in the anterior temporal lobe (a), external capsules, periventricular regions (b), and white matter (c). MR angiography revealed the patency of the right STA-MCA double anastomoses (d)
Mentions: The post-operative course was uneventful. On post-operative day 1, an IMP-SPECT study showed a 50 % increase in uptake in the right MCA territory but not hyperperfusion, and MRI demonstrated the patency of the double anastomosis (data not shown). IMP-SPECT images obtained 1 month after surgery showed improved regional CBF (Fig. 4c) and CVR (Fig. 4d) in the right hemisphere. No hemorrhagic complications occurred. After surgery, the patient’s preoperative symptoms were relieved, and the TIAs disappeared. The patient was discharged 12 days after surgery. Sixteen months have already passed since surgery, and the patient is doing well. Cerebrovascular events such as TIA, infarction and hemorrhage have not appeared. Follow up MRI 14 months after surgery showed no remarkable area of increased intensity indicating white matter abnormalities in the left anterior temporal lobe, both anterior frontal lobes, external capsules, or periventricular regions on FLAIR images (Fig. 5a–c). MR angiography was used to confirm the patency of the bypass (Fig. 5d).Fig. 5

Bottom Line: Ischemic events are the main clinical manifestation of this condition.Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses.To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjyo, Chuoku, Kumamoto, 8608556 Japan.

ABSTRACT
Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy is a rare hereditary small vessel disease. Ischemic events are the main clinical manifestation of this condition. Here, we present a case in which superficial temporal artery-to-middle cerebral artery anastomosis was performed in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who developed cerebral infarctions caused by severe middle cerebral artery stenosis. Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses. To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature. Superficial temporal artery-to-middle cerebral artery anastomosis is effective for patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who show marked regional cerebral hypoperfusion.

No MeSH data available.


Related in: MedlinePlus