title: Perioperative complications of superficial temporal artery to middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms.
abstract: OBJECTIVE
  Only a few studies have reported the risk of ischemic complications occurring when superficial temporal artery (STA) to middle cerebral artery (MCA) anastomosis is performed during surgery for complex MCA aneurysms.
  
  
  METHODS
  This is a retrospective study of 10 patients (age 52-73) with MCA aneurysms treated with revascularization surgery. The aneurysms were 10-50mm in size (mean: 21mm). We studied the causes and frequency of ischemic complications by analyzing postoperative magnetic resonance imaging.
  
  
  RESULTS
  Postoperative diffusion-imaging confirmed ischemic complications in six of the 10 patients (in two of the five ruptured aneurysms and in four of the five unruptured). The ischemic complications that observed were infarction of the lenticulostriate artery territory in three cases, cortical infarction in two cases, and cerebral infarction that was likely to be due to cerebral vasospasm in one case. In one case, both cortical infarction and infarction of the lenticulostriate artery territory were observed. The Glasgow Outcome Scale (GOS) scores at the time of discharge indicated good recovery (GR) and moderate disability (MD) in seven cases, severe disability (SD) in two cases, and death (D) in one case.
  
  
  CONCLUSIONS
  The present study suggests the possibility that STA-MCA anastamosis in surgeries for MCA aneurysms can be performed with comparatively better safety. However, the temporary occlusion time with this surgery is longer than that with a temporary clipping for aneurysmal surgery; thus, we believe that adequate countermeasures are required to prevent ischemic complications.
authors.affiliation: Department of Neurosurgery, Nippon Medical School, Tokyo, Japan. s00-078@nms.ac.jp
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Matano
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Murai
authors.forename: Kojiro
authors.initials: K
authors.lastname: Tateyama
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mizunari
authors.forename: Katsuya
authors.initials: K
authors.lastname: Umeoka
authors.forename: Kenta
authors.initials: K
authors.lastname: Koketsu
authors.forename: Shiro
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Akira
authors.initials: A
authors.lastname: Teramoto
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D017542:Aneurysm, Ruptured / Q000401:mortality; D020201:Brain Hemorrhage, Traumatic / Q000150:complications / Q000473:pathology / Q000601:surgery; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology* / Q000628:therapy; D020127:Recovery of Function; D012189:Retrospective Studies; D013699:Temporal Arteries / Q000601:surgery*