Prevention of secondary ischemic events by superficial temporal artery-middle cerebral artery bypass surgery after tuberculosis-induced vasculopathy in a 5-year-old child.
Tuberculosis-related vasculopathy and resulting ischemic events are a common finding after tuberculous meningitis (TBM) in children. The authors report on a case of recurring ischemic episodes that were refractory to repetitive endovascular procedures (transluminal angioplasty, stent insertion, in-stent vessel dilation). After failure of endovascular treatment, extracranial-intracranial (EC-IC) bypass surgery was performed to prevent further ischemia. This 5-year-old girl presented with a series of ischemic events in the left middle cerebral artery (MCA) territory 12 months after her presentation with TBM. Angiography studies showed a 50% lumen reduction of the left MCA. After failure of antithrombocyte aggregation and repeated endovascular procedures to prevent new ischemia, EC-IC bypass surgery was performed. The left superficial temporal artery-MCA bypass was found to be capable of preventing new ischemic events in the 21-month follow-up period, despite a near-total MCA occlusion on follow-up conventional and MR angiography studies. Bypass surgery seems to be a reliable tool to augment cerebral blood flow in tuberculosis-related stenoocclusive changes of cerebral vasculature after the failure of endovascular procedures.
Misch
Martin
M
Department of Neurosurgery, Charité Campus Virchow, Medical University of Berlin, Berlin, Germany. martin.misch@charite.de
Thomale
Ulrich-Wilhelm
UW
Keitzer
Rolf
R
Vajkoczy
Peter
P
D000800:Angioplasty, Balloon; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000517:prevention & control; D033183:Interdisciplinary Communication; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D010348:Patient Care Team; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D055502:Secondary Prevention; D015607:Stents; D016862:Tuberculoma, Intracranial / Q000188:drug therapy / Q000601:surgery*; D014390:Tuberculosis, Meningeal / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt
D000995:Antitubercular Agents; D010975:Platelet Aggregation Inhibitors