Abstract
Regional cerebral blood flow (rCBF) was measured by the Xe-133 inhalation method in sixty patients before and after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, which was performed in the chronic stage. The aim of this study was to assess the effect of the surgery on rCBF and to obtain objective criteria for the surgery. The results were as follows: 1) A close relationship was found between the postoperative changes in mean hemispheric CBF (mCBF) and the preoperative states such as the site of lesion, the degree of occlusion, the size and location of infarction, and the degree of ischemia. 2) In patients with major artery occlusion, mCBF increased in those with no or a smaller infarction in the cortex, and the degree of improvement was more pronounced in those with internal carotid artery occlusion than in those with middle cerebral artery occlusion. 3) In patients with major artery stenosis, mCBF decreased slightly but significantly within one month after the surgery, and it returned gradually to near the previous levels. 4) An increase in mCBF occurred in patients with a severely reduced flow before surgery, and a slight decrease occurred in those with a nearly normal level. 5) The degree of intracranial filling via the anastomosis was good in patients with major artery occlusion with no or a smaller infarction, and was more correlated with the improvement of laterality, which was the difference of mCBF compared between the hemispheres, than improvement of the mCBF in an affected hemisphere.
In conclusion, anastomosis seems to be useful for patients with major artery occlusion, a relatively small infarction and a severely reduced flow, and the indication in patients with major artery stenosis needs further investigation.
