Superficial Temporal to Proximal Superior Cerebellar Artery Anastomosis for Basilar Artery Stenosis

Abstract

A newly modified revascularization procedure for vertebrobasilar insufficiency due to midbasilar stenosis is reported. The approach involves anastomosing the superficial temporal artery to a proximal segment of the superior cerebellar artery. The rationale for the procedure and the surgical technique are discussed.

Orthostatic transient ischemic attacks: a symptom of large vessel occlusion.

“…Barnett 4 described a patient with basilar artery occlusion who developed orthostatic TIAs as a result of iatrogenic orthostatic hypotension. A patient with orthostatic TIAs reported by Ausman and colleagues 5 had greater than 90 per cent stenosis of the basilar artery which progressed to complete occlusion within three weeks. Orthostatic TIAs occurred in a patient with bilateral vertebral artery occlusions reported by Hopkins and colleagues.…”

Flow-assisted surgical cerebral revascularization

“…The use of bypass for revascularization in patients with posterior fossa ischemia has been less studied than anterior circulation disease because of the relative prevalence of the conditions, the availability and evolution of endovascular techniques for treatment of vertebrobasilar stenosis, the relatively higher complication rate, and the technical complexity of posterior circulation revascularization. Existing studies indicate, however, the feasibility of various EC-IC bypass options to the posterior circulation, including occipital artery-posterior inferior cerebellar artery, 11,34 superior cerebellar artery-posterior cerebral artery, 49 STA-posterior cerebral artery, 9 and STA-superior cerebellar artery 10 bypasses. Symptomatic vertebrobasilar disease, particularly if intracranial vessels are affected, carries a high risk of stroke, averaging 10-15% per year despite medical therapy.…”

“…The focus was on the technical ability to perform various bypass procedures with the implicit understanding that patients with carotid occlusion and ischemia would benefit from revascularization. Pioneering work by Spetzler and Chater, 47 Tew, 53 Ausman and colleagues, 10,11 Khodadad, 34 Sundt et al, 50 and others set standards for surgical technique. As techniques became more standardized, the number of bypass procedures increased rapidly.…”

Study of the variations of superior cerebellar artery in human cadavers

“…3 The present study was undertaken mainly to know the anatomical variations in the origin and dimensions of the proximal segment of SCA in south Indian population so that the data can be of benefit to the anatomist, radiologist and the neurovascular surgeons.…”

“…9,10 Bypass procedures can reduce mortality and morbidity and the knowledge of the anatomic features like origin, diameter, and course of the vasculature plays an important role in preoperative planning of the appropriate branches and location for the anastomosis. 3,[9][10][11] In this study the outer diameter of the BA at its apex ranged from 3.2-6 mm. Shrontz C has recorded the outer diameter of the distal BA as 4.1 ± 0.1 mm and at the level of SCA origin as 3.5 ± 0.2 mm.…”