Superficial temporal artery to middle cerebral artery anastomosis

Little, John R.; Yamamoto, Yusuke; Feindel, William; Meyer, E.; Hodge, Charles P.

doi:10.3171/jns.1979.50.5.0560

Cited by 47 publications

(10 citation statements)

References 13 publications

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“…12 Little, et al, using intraoperative fluorescein angiography and X e m clearance, demonstrated an immediate substantial increase (15 ml/100 g/min) in 73% of their patients undergoing STA-MCA bypass. 7 They found a general increase in cortical flow but did not describe what changes occurred in areas without reduced flows. They did not find the variability in rCBF which we found.…”

Section: Discussionmentioning

confidence: 95%

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Cortical blood flow during extracranial-intracranial bypass surgery.

Carter¹,

Crowell²,

Sonntag³

et al. 1984

Stroke

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SUMMARY Cortical Mood flow was evaluated at the time of surgery with a thermal diffusion flow probe in 25 extracranial-intracranial bypass operations. The procedures were performed 14 times for carotid occlusion, 6 times for inaccessible carotid stenosis, on 3 occasions for middle cerebral occlusion, once for basilar occlusion and once for middle cerebral stenosis. Fifty-seven different cortical regions were evaluated before and after completion of the anastomosis.During temporary occlusion of the cortical vessel, no significant changes in cortical blood flow were identified. The mean flow pre-bypass was 58 ml/100 g/min and postbypass was 66. This was a significant difference. When Initial ischemic areas were evaluated, flows increased from 36 ml/100 g/min to 52 ml/100 g/ min. These postbypass flows were statistically different than the flow values in the nonischemic areas of 75 ml/100 g/min. Blood pressure and arterial carbon dioxide tension did not vary significantly.Extracranial-intracranial bypass increases cortical flow in ischemic areas although this does not bring the flow into the normal range. Stroke Vol 15, No 5, 1984 THE RATIONALE for extracranial-intracranial (EC-IC) bypass is to provide an additional conduit into the vascular bed in order to improve blood flow in ischemic regions. Pre-and postoperative cerebral blood flow (CBF) studies have shown increased flow.

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Section: Discussionmentioning

confidence: 95%

“…Little et al, showed improved CBF acutely at surgery using Xe 133 clearance studies and fluorescein angiography. 7 To evaluate acute changes in CBF at surgery, we employed a thermal diffusion flow probe which was previously calibrated against Xe l33 clearance. This allows a continuous monitor of regional CBF (rCBF) during the operative procedure.…”

mentioning

confidence: 99%

Cortical blood flow during extracranial-intracranial bypass surgery.

Carter¹,

Crowell²,

Sonntag³

et al. 1984

Stroke

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“…Wrobel et al (32) reported a case of high-dose FNa videoangiography using 2,000 mg IV bolus. In other neurosurgical reports, IV doses range from 75 mg to 500 mg per bolus (6, 18–21, 30, 31, 33) or from 1 mg/kg to 1.5 mg/kg per body weight (16, 34).…”

Section: Dosages Of Fna For Vascular Applicationsmentioning

confidence: 99%

Application of Fluorescein Fluorescence in Vascular Neurosurgery

et al. 2019

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Background: Fluorescein sodium (FNa) is a fluorescent drug with a long history of use for assessing retinal blood flow in ophthalmology; however, its application in vascular neurosurgery is only now gaining popularity. This review summarizes the current knowledge about using FNa videoangiography in vascular neurosurgery.Methods: We performed a literature review on the usage of FNa for fluorescent videoangiography procedures in neurosurgery. We analyzed methods of injection, dosages of FNa, visualizing platforms, and interpretation of FNa videoangiography. We also reviewed practical applications of FNa videoangiography during various vascular neurosurgeries.Results: FNa videoangiography can be performed with intraarterial (intracarotid) or intravenous dye injections. Both methods provide excellent resolution with enhanced fluorescence that shows intravascular blood flow on top of visible surrounding anatomy, and both allow simultaneous purposeful microsurgical manipulations. Although it is invasive, an intracarotid FNa injection results in faster contrast appearance and higher-intensity fluorescence and requires a lower dose per injection (reported range, 1–50 mg) compared with peripheral intravenous FNa injection (reported range, 75–2,000 mg or 1–1.5 mg/kg body weight). Four optical excitation/detection tools for FNa videoangiography have been successfully used: conventional xenon-light operating microscope with a special filter set, pencil-type light-emitting diode probe with a filter set, laser-illumination operating microscope, and an endoscope with a filter set. FNa videoangiography was reported to be feasible and useful in various clinical scenarios, such as examining the feeders and drainers in arteriovenous malformation surgery, checking the patency of a microvascular anastomosis, and assessing blood flow during aneurysm clipping. FNa videoangiography can be repeated during the same procedure and used along with indocyanine green (ICG) videoangiography.Conclusions: Compared with ICG videoangiography, FNa videoangiography has the advantages of enabling real-time inspection and better visualization at deep locations; however, thick vessel walls limit visualization of FNa in larger vessels. FNa videoangiography is a useful tool in multiple neurovascular scenarios and merits further studies to establish its clinical value.

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“…[592] In the field of neurosurgery, fluorescein has been used in cerebral angiography to detect arteriovenous malformations,[26] superficial temporal artery-middle cerebral artery anastomoses,[60] and to aid in treating cerebral aneurysms. [122]…”

Section: Fluorescein Sodiummentioning

confidence: 99%

Neurosurgical confocal endomicroscopy: A review of contrast agents, confocal systems, and future imaging modalities

et al. 2014

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Background:The clinical application of fluorescent contrast agents (fluorescein, indocyanine green, and aminolevulinic acid) with intraoperative microscopy has led to advances in intraoperative brain tumor imaging. Their properties, mechanism of action, history of use, and safety are analyzed in this report along with a review of current laser scanning confocal endomicroscopy systems. Additional imaging modalities with potential neurosurgical utility are also analyzed.Methods:A comprehensive literature search was performed utilizing PubMed and key words: In vivo confocal microscopy, confocal endomicroscopy, fluorescence imaging, in vivo diagnostics/neoplasm, in vivo molecular imaging, and optical imaging. Articles were reviewed that discussed clinically available fluorophores in neurosurgery, confocal endomicroscopy instrumentation, confocal microscopy systems, and intraoperative cancer diagnostics.Results:Current clinically available fluorescent contrast agents have specific properties that provide microscopic delineation of tumors when imaged with laser scanning confocal endomicroscopes. Other imaging modalities such as coherent anti-Stokes Raman scattering (CARS) microscopy, confocal reflectance microscopy, fluorescent lifetime imaging (FLIM), two-photon microscopy, and second harmonic generation may also have potential in neurosurgical applications.Conclusion:In addition to guiding tumor resection, intraoperative fluorescence and microscopy have the potential to facilitate tumor identification and complement frozen section analysis during surgery by providing real-time histological assessment. Further research, including clinical trials, is necessary to test the efficacy of fluorescent contrast agents and optical imaging instrumentation in order to establish their role in neurosurgery.

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Superficial temporal artery to middle cerebral artery anastomosis

Cited by 47 publications

References 13 publications

Cortical blood flow during extracranial-intracranial bypass surgery.

Cortical blood flow during extracranial-intracranial bypass surgery.

Application of Fluorescein Fluorescence in Vascular Neurosurgery

Neurosurgical confocal endomicroscopy: A review of contrast agents, confocal systems, and future imaging modalities

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