Effect of Adventitial Dissection of Superficial Temporal Artery on the Outcome of Superficial Temporal Artery-Middle Cerebral Artery Bypass in Moyamoya Disease

Abstract

Superficial temporal artery-middle cerebral artery (STA-MCA) has been used for the treatment of occlusive cerebrovascular disease including moyamoya disease. The effect of STA-MCA bypass depends not only on the patency of anastomosis, but also on integrity and functional capacity of the donor artery. In the present prospective study, we investigated the effect of extensive stripping STA adventitia and fasciae on hemodynamic function in STA-MCA bypass of moyamoya disease patients. Twenty patients (n=8 in control group, n=12 in stripping group) of moyamoya disease were subjected to STA-MCA end-to-side direct anastomosis. Perfusion unit (PU) values of the cortex were measured and recorded using a Laser Doppler flowmetry (LDF) for 5 days. Computed tomography perfusion was performed to determine blood flow before and after bypass. No patient experienced significant neurologic deficits associated with neurosurgical complications. LDF demonstrated that adventitial stripping group had higher cerebral blood flow increase than control group. The adventitia stripping group tends to have higher rate of increased cerebral perfusion after bypass than non-stripping group. Furthermore, the ultrasound examination at 3 days after bypass demonstrated that the adventitial stripping group has a tendency of bigger STA and higher peak systolic velocity than control group. Our result suggests that stripping adventitia of STA improves hemodynamics of STA-MCA bypass in moyamoya disease.

Combination of intraoperative indocyanine green video-angiography FLOW 800 and computed tomography perfusion to assess the risk of cerebral hyperperfusion syndrome in chronic internal carotid artery occlusion patients after revascularization surgery

“…A higher STA blood flow results in abnormally high local cerebral perfusion. It was verified that after anastomosis, the circulatory resistance of distal STA suddenly and significantly decreased, and the blood flow of the receptor passively increased (32). If the STA undergoes compensatory thickening after bypass, patients will show higher rates of headache (33).…”

Intraoperative Neuroendovascular Rescue Therapy for Severe Donor Artery Vasospasm In Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery: A Case Report

“…[5] Third, sympathetic nerve endings observed in STA adventitia were also highly related to the development of the graft vasospasm [6]. Stripping of STA adventitia has been shown to improve hemodynamic function of STA, [7] but the extent of the stripping should be limited to the distal segment of the STA in order to preserve the vasovasorum which supplied the STA pedicle. With all the techniques mentioned above, the flow within the donor vessel may still becom promised in the different time frames following the anastomosis.…”