title: A3-A3 anastomosis and superficial temporal artery-radial artery graft-A3 bypass to treat bilateral ACA steno-occlusive hemodynamic ischemia with cognitive and executive dysfunction: a technical note.
abstract: BACKGROUND
  Executive functions are complex cognitive control functions that include cognitive flexibility, inhibition (self-control, self-regulation), and working memory. Bilateral frontal lobe ischemia is associated with cognitive impairment, especially in the context of dysexecutive syndrome. This report describes two patients who underwent bilateral anterior cerebral artery (ACA) reconstruction by A3-A3 anastomosis in conjunction with superficial temporal artery (STA)-radial artery (RA) graft-A3 bypass to treat bilateral ACA steno-occlusive hemodynamic ischemia accompanying cognitive and executive dysfunction.
  
  
  METHODS
  A 74-year-old woman and a 73-year-old woman were admitted to our hospital for unilateral cerebral infarction in the frontal lobe. Magnetic resonance angiogram (MRA) demonstrated severe bilateral ACA steno-occlusive pathology in both patients. Considering the presence of impaired cognitive function with dysexecutive syndrome as well as hemodynamic compromise shown by single photon emission computed tomography (SPECT), we proceeded with A3-A3 anastomosis in conjunction with STA-RA-A3 bypass. Various neuropsychiatric tests were performed before and after the surgery.
  
  
  RESULTS
  We confirmed good bypass patency without periprocedural complications. One patient recovered from apallic and bedridden status and regained ambulatory condition and ability to take in an oral diet. Another patient demonstrated improved scores in several cognitive tests with some persistent executive dysfunction.
  
  
  CONCLUSIONS
  Bilateral ACA revascularization was technically feasible in two patients. This bypass surgery could have some positive effects in some basic cognitive function, such as memory, attention, and concentration by bilateral ACA hemodynamic improvement, although executive function, which is specific to prefrontal function, might not be reversible.
authors.affiliation: Department of Neurosurgery, Fuji Brain Institute and Hospital, 270-12 Sugita, Fujinomiya City, Shizuoka, 418-0021, Japan, kiyofuji-tky@umin.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kiyofuji
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Inoue
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Akira
authors.initials: A
authors.lastname: Tamura
authors.forename: Isamu
authors.initials: I
authors.lastname: Saito
mesh_terms: D000368:Aged; D020771:Anterior Cerebral Artery / Q000601:surgery*; D002544:Cerebral Infarction / Q000209:etiology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000601:surgery; D003072:Cognition Disorders / Q000209:etiology / Q000601:surgery*; D003251:Constriction, Pathologic; D056344:Executive Function; D005260:Female; D006801:Humans; D017534:Radial Artery / Q000637:transplantation*; D013699:Temporal Arteries / Q000637:transplantation*