Superficial temporal artery-vein-middle cerebral artery anastomosis

Since Yasargil and Donaghy pioneered the superficial temporal artery-brain artery anastomosis in 1967 to treat cerebral ischemic diseases, various forms of extracranial-cranial anastomosis have emerged in an endless stream, counting up to 10 species, each with its own advantages and disadvantages. . Tew first reported this type of surgery in 1975. Treatment of diseases: temporomandibular joint disease Indication It is suitable for patients with superficial temporal artery-brain artery anastomosis, but the branch of superficial temporal artery is too small (inner diameter <1mm), or other pathological changes, it is not suitable for use as a blood supply artery. Contraindications 1. Older patients, with severe systemic diseases such as lung, heart, kidney, liver disease, diabetes, etc. 2. There are already serious and persistent neurological dysfunctions. 3. Although there is stenosis or occlusion of the internal carotid artery or middle cerebral artery, but no neurological symptoms, cerebral blood flow (CBF) is also normal, indicating that the collateral circulation is sufficient. 4. There is extensive cerebral infarction in the blood supply area or inner capsule of the middle cerebral artery. It is estimated that even if the anastomosis is successful, it is difficult to improve the symptoms. Preoperative preparation 1. Adequate cerebral angiography, including bilateral carotid angiography and at least one side of vertebral angiography, should be comprehensively understood for cerebral vascular stenosis and collateral circulation. 2. CT scan to determine the presence and extent of cerebral infarction. 3. Determination of cerebral blood flow. 4. Prepare the scalp as usual. 5. Give preventive antibiotics. Surgical procedure Incision In the front of the ear, a shallow incision is made upwards at the pulsation of the superficial artery, which is about 10 cm long. The main artery of the superficial temporal artery is isolated and pursued to the far side. If it is confirmed that the branch is too small, it is not suitable for use as a blood supply artery, that is, a vein graft bridge is adopted. 2. Take the vein Take a vein from the forearm, about 8cm long, 3 ~ 4mm in diameter, flush the blood in the lumen with heparin saline, stored in 1% procaine solution for use. 3. Craniotomy The craniotomy was performed 6 cm above the outer ear hole, and the branch of the middle cerebral artery was searched for the bloody artery in the lateral fissure. 4. Anastomotic artery The venous segment was taken and the broken end was trimmed. The proximal end and the superficial temporal artery trunk were end-to-side anastomosis, and the distal end and the middle cerebral artery branch were end-to-side. The anastomosis technique is the same as the superficial temporal artery-brain artery anastomosis.