Superficial temporal artery-superior cerebellar artery bypass with anterior petrosectomy: Technical Case Report.

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Superficial temporal artery-superior cerebellar artery bypass with anterior petrosectomy: Technical Case Report.

World Neurosurg. 2018 Mar 24;:

Authors: Hokari M, Asaoka K, Shimbo D, Uchida K, Itamoto K

Abstract
BACKGROUND: Superficial temporal artery (STA) -to- superior cerebellar artery (SCA) bypass is associated with a relatively high risk of surgical complications, such as hematoma and/or edema caused by temporal lobe retraction. Therefore, the right side is typically used to avoid retraction of the left temporal lobe. In this report, we present a case of left STA-SCA bypass with anterior petrosectomy to avoid retraction of dominant side temporal lobe and describe the surgical technique in detail.
CLINICAL PRESENTATION: A 69-year-old man presented with gradual worsening of dysarthria and gait disturbance. MRI showed no signs of acute infarction, but digital subtraction angiography (DSA) showed severe stenosis of basilar artery and faint flow in the distal basilar artery. On 3-dimensional CT angiography (3D-CTA), posterior communicating arteries were not visualized; we could identify the left SCA, but not the right SCA. In spite of dual antiplatelet therapy, a small fresh brain stem infarct was detected 10 days after admission. To avert fatal brain stem infarction and further enlargement of the infarct, we performed left STA-SCA bypass with anterior petrosectomy to avoid retraction of the dominant side temporal lobe. Postoperative imaging revealed no new lesions such as infarction or temporal lobe contusional hematoma, and confirmed the patency of the bypass. Post-operative single-photon emission computed tomography (SPECT) demonstrated improved cerebral blood flow in the posterior circulation. The patient was transferred to another hospital for rehabilitation.
CONCLUSIONS: This method helps minimize the risk of injury to temporal lobe, especially that of the dominant side.

PMID: 29588240 [PubMed - as supplied by publisher]

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