不安定性椎骨脳底動脈血流不全に対する亜急性期浅側頭動脈─上小脳動脈吻合術

抄録

Patients with posterior circulation insufficiency often have a poor prognosis despite aggressive medical treatment. We performed nine superficial temporal artery to superior cerebellar artery (STA-SCA) anastomosis for such unstable patients between December 2008 and December 2012. Surgery was performed using the subtemporal approach. The floor of the middle fossa was shaved flat and the tentorium was incised to obtain sufficient working space. The vein of Labbé and other temporal bridging veins were detached from the brain to facilitate retraction of the temporal lobe. The patency of the anastomosis was confirmed using indocyanine-green (ICG) videoangiography and Doppler ultrasonography. Postoperatively, all the patients showed clinical and radiological improvement of vertebrobasilar insufficiency. Temporal contusion was not observed on the postoperative MRI’s in the present series. Transient trochlear nerve palsy was observed in five patients.
STA-SCA anastomosis is effective in selected patients with refractory vertebrobasilar insufficiency, and the procedure is safe when performed by expert neurosurgeons.