Superficial temporal artery-middle cerebral artery microvascular bypass: Its role in treatment of patients with moyamoya disease, cerebral aneurysms, and vascular occlusive disease

Lea Kahanov, José E. Cohen, Shifra Fraifeld, Cezar Mizrahi, Ronen R. Leker, Samuel Moscovici, Sergey Spektor

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Superficial temporal artery-middle cerebral artery microvascular bypass (STA-MCA MVB) is an important strategy for the management for selected patients. Objective: To present our 19-year experience with STA-MCA MVB. Methods: Data for consecutive patients who underwent STA-MCA MVB from 2000-2019 due to moyamoya/moyamoya-like disease, complex intracranial aneurysms, or intractable brain ischemia due to internal carotid artery or MCA occlusive disease with repeated ischemic events were retrospectively analyzed under a waiver of informed consent. Key surgical steps and the important role of neuroendovascular interventions are presented. Surgical results and late outcomes were analyzed. Results: The study was comprised of 32 patients (17 women [53%], 15 men [47%]), mean age 42.94 years (range 16-66). Patients underwent 37 STA-MCA MVB procedures during the study period; 22 with moyamoya/moyamoya-like disease (69%) underwent 27 surgeries (five bilateral); 7 with complex aneurysms (22%) and 3 with vascular occlusive disease (9%) underwent unilateral bypass. Five of seven aneurysms were treated with coiling or flow-diverter stent implant prior to bypass surgery; two were clipped during the bypass procedure. There were no surgical complications, no perioperative mortality, and no death from complications related to neurovascular disease at late follow-up. Transient neurological deficits following 8/37 (21%) resolved with no permanent neurologic sequelae. Transient ischemic attacks occurred only in the immediate postoperative period in four patients (11%). Conclusions: In specific cases, STA-MCA MVB is a feasible and clinically effective procedure. It is important to preserve this technique in surgical armamentarium.

Original languageEnglish
Pages (from-to)306-311
Number of pages6
JournalIsrael Medical Association Journal
Volume23
Issue number5
StatePublished - 1 May 2021
Externally publishedYes

Keywords

  • Cerebral aneurysm
  • Cerebral ischemia
  • Moyamoya disease
  • Occlusive cerebrovascular disease
  • Revascularization

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