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.
|Number of pages||6|
|Journal||Israel Medical Association Journal|
|State||Published - 1 May 2021|
- Cerebral aneurysm
- Cerebral ischemia
- Moyamoya disease
- Occlusive cerebrovascular disease