Posterior Circulation EC–IC Bypass via Supracerebellar Transtentorial SCTT Approach Applied in a Young Patient with Congenital Multiple Occlusive Cerebrovascular Anomalies – Case Report and Technical Note
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Abstract
A case of remarkable vertebrobasilar insufficiency due to congenital multiple occlusive cerebro-vascular anomalies is presented. Anomalies are of the anterior and posterior circulation, presumably induced by “segmental vulnerability” and modified by infection of recurrent tonsillitis. Symptoms of repeated faintness and black-out attacks and deterioration of cognitive function compromised the quality of life considerably. Successful treatment was achieved by combination of a new type of posterior circulation revascularization procedure, namely occipital artery – superior cerebellar artery bypass via the supracerebellar transtentorial SCTT approach in the sitting position in combination with a standard superficial temporal artery STA–MCA bypass.
Keywords
Vertebrobasilar insufficiency Cerebrovascular occlusive disease Segmental vulnerability Posterior circulation revascularization Transtentorial supracerebellar approach.Notes
Acknowledgement
The author is indebted to Ms R. Frick for secretarial assistance, Mr. P. Roth for the artist’s drawing, Ms PD Dr. Khan for English correction and Dr. M. Curcic, anaesthesiologist, for longstanding cooperation.
References
- 1.Yasargil MG (1969) Microsurgery applied to neurosurgery. Thieme, Stuttgart, pp 105–115Google Scholar
- 2.Ausman JL, Diaz FG, De Los Reyez RA et al (1982) Posterior circulation revascularization; superficial temporal artery to superior cerebellar artery anastomosis. J Neurosurg 56:766–776PubMedCrossRefGoogle Scholar
- 3.Khodadad G, Singh RS (1977) Olinger CP(1977) Possible prevention of brain stem stroke by microvascular anastomosis in the vertebrobasilar system. Stroke 8:316–321PubMedCrossRefGoogle Scholar
- 4.Sundt TM, Piepgras DG, Hauser W et al (1982) Interposition saphenous vein graft for advanced occlusive disease and large aneurysms in the posterior circulation. J Neurosurg 56:205–215PubMedCrossRefGoogle Scholar
- 5.Yonekawa Y, Imhof HG, Taub E, Curcic M, Kaku Y, Roth P, Wieser HG, Groscurth P (2001) Supracerebellar transtentorial approach posterior temporomedial structures. J Neurosurg 94:339–345PubMedCrossRefGoogle Scholar
- 6.Yasargil MG (1967) Experimental small vascular surgery in the dog including patching and grafting of cerebral vessels and the formation of functional extra-intracranial shunts. In: Donaghy RMP, Yasargil MG (eds) Microvascular surgery. Thieme, Stuttgart, pp 87–126Google Scholar
- 7.Yonekawa Y, Frick R, Roth P, Taub E, Imhof HG (1999) Laboratory training in microsurgical techniques and microvascular anastomosis. Oper Tech Neurosurg 2:149–158CrossRefGoogle Scholar
- 8.Yonekawa Y, Yasargil MG (1976) Extra-intracranial arterial anastomosis. Clinical and technical aspects. Results. Adv Tech Stand Neurosurg 3:47–78Google Scholar
- 9.Huber P (1982) Krayenbühl/Yasargil cererbal angiography. Thieme, Stuttgart, pp 57–61Google Scholar
- 10.Fukui M, Members of research committee on spontaneous occlusion of the circle of Willis (Moyamoya disease) of the Ministry of Health and Welfare, Japan (1997) Guidelines for the diagnosis and treatment of spontaneous occlusion of the circle of Willis (Moyamoya disease). Clin Neurol Neurosurg 99(Suppl 2):238–240Google Scholar
- 11.Yonekawa Y, Taub E (1999) Moyamoya disease: status 1998. Neurology 5:13–23CrossRefGoogle Scholar
- 12.Kutsuzawa Y, Members of research committee on spontaneous occlusion of the circle of Willis of the Ministry of Health and Welfare, Japan (1979) Diagnostic criteria of fibromuascular dysplasia. In: Goto F (ed), Annual report 1978 of the research committee on spontaneous occlusion of the circle of Willis of the Ministry of Health and Welfare, Japan. Tokyo, p 133Google Scholar
- 13.Lasjaunias PL (2000) Segmental identity and vulnerability in cerebral arteries. Interv Neuroradiol 6:113–124PubMedGoogle Scholar
- 14.Komiyama M (2003) Moyamoya disease is a progressive occlusive arteriopathy of the primitive internal carotid artery. Interv Neuroradiol 9:39–45PubMedGoogle Scholar
- 15.Yonekawa Y(1989) Problems and their management in the operating sitting position. Neurosurgeons 8: 50–58 (Jpn. Abstract: English)Google Scholar