Abstract
Although conventional anastomosis of the superficial temporal artery (STA) to the cortical branch of the middle cerebral artery (MCA) is a common procedure in many parts of the world, postoperative angiography shows that, in terms of MCA branch filling, the results are not as good as might be expected. In an attempt to achieve good perfusion of the branches of the MCA, the authors anastomosed the STA and MCA in the sylvian fissure just distal to the trifurcation (STApMCA anastomosis) in 11 patients between March, 1983 and June, 1985. Ten had ischemic cerebrovascular lesions and one had a saccular aneurysm at the cavernous portion of the internal carotid artery. Postoperative quality of life was excellent in seven cases and good in four. On angiograms obtained 1 month after surgery, visualization of the MCA was excellent in seven cases, good in one, and poor in two; an occlusion persisted in one.
One advantage of this procedure is the immediate restoration of flow into the MCA tree via a larger caliber anastomosis than is possible with a standard cortical bypass. In addition, postoperative angiography allows better visualization of the MCA tree than is achievable with conventional STA-MCA anastomosis. The disadvantages are that one of the main branches of the MCA must be temporarily occluded, new instruments must be prepared for the anastomosis in the sylvian fissure, and the anastomosis must be performed deep in the sylvian fissure. None the less, STA-pMCA anastomosis is a satisfactory alternative in cases of transient ischemic attack, reversible ischemic neurological deficits, and minor completed stroke caused by occlusion or stenosis of the internal carotid artery.
