title: Superficial temporal artery to middle cerebral artery anastomosis for neovascular glaucoma due to common carotid artery occlusion.
abstract: BACKGROUND
  Common carotid artery (CCA) occlusion sometimes requires surgical revascularization to resolve persistent cerebral/ocular ischemia. High-flow bypass is often indicated in these cases, using the interposed graft such as saphenous vein and radial artery. However, high-flow bypass surgery is invasive and may provide excessive blood flow to ischemic brain. In this report, we present a case that developed neovascular glaucoma due to CCA occlusion and was successfully treated with superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis.
  
  
  METHODS
  A 61-year-old male complained of left visual disturbance and was admitted to our hospital. He underwent carotid endarterectomy for left internal carotid artery stenosis in previous hospital 1-year before, but he experienced left visual disturbance after surgery. Postoperative examinations revealed that the CCA was occluded. His visual disturbance gradually progressed, and he was diagnosed as neovascular glaucoma. None of ophthalmological therapy could improve his symptoms. Blood flow measurement showed an impaired reactivity to acetazolamide in the left cerebral hemisphere. Cerebral angiography demonstrated that the left STA was opacified through the muscular branches from the left deep cervical artery. Therefore, he successfully underwent left STA-MCA double anastomosis. His visual acuity improved and new blood vessels around the iris markedly decreased 3 months after surgery.
  
  
  CONCLUSIONS
  Precise radiological examination may enable standard STA-MCA anastomosis even in patients with CCA occlusion.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
authors.forename: Daina
authors.initials: D
authors.lastname: Kashiwazaki
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Akioka
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Kuwayama
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
keywords: Common carotid artery occlusion; neovascular glaucoma; superficial temporal artery to middle cerebral artery anastomosis