Abstract
Eighty cases underwent the STA-MCA bypass 83 times by one of the authors during the last five years. Some parts of the results have been reported elsewhere. Complications and their countermeasures are now discussed. Patency of the bypass graft has been 83% in the early cases and 100% in the last 20 cases. Overall mortality is 3.6% and morbidity 4.8%.
Two patients died of cerebellar hemorrhage due to a post-operative hypertension above 220 mmHg of systolic pressure. The other died of septicemia following skin flap infection. Deterioration of neurological deficits took place in four cases; two cases of stroke in spite of patent bypass, the other cases of malignant hyperthermia and subdural hematoma respectively. Subdural hematoma complicated in two cases, which include the morbid case mentioned above and the other case recovered from aphasia completely after the removal of the hematoma. Infection was recognized in three cases, which includes the case of septicemia described already and the other two cases with only localized skin flap infection. Marginal skin necrosis treated conservatively without further problems was observed in four cases. Three cases suffered from convulsive seizures postoperatively.
Postoperative hypertension, subdural hematoma and infection seem to be the most important clinical features which would provoke serious neurological deficits and their countermeasures should be performed promptly and efficiently.
