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Results for “Cerebral Revascularization”

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PubMed1985

[Cerebral revascularization (modified extra-intracranial anastomosis)].

Cerebrovascular diseases show a worldwide increase (in the U.S.A. alone about 400,000 new diseases every year) and the average age of the affected patients decreases significantly. The extra-intracranial anastomoses has proved to be a prophylactic measure for preventing a cerebral infarction after TIA and an efficient therapy for the improvement of the situation of the apoplectic patients. Since, however, in cerebrovascular diseases the donor artery is usually also affected, a modification of the method and a simplification of the surgical technique have been developed. In this modification, an interponate for bridging the cerebral vessels and the main stem of the donor artery is used and because of its optional length the region affected by the insufficient blood circulation can be directly supplied. A report is given on the technique this of method, the reduction of the duration of the operation and the effectiveness of the intervention.

Adult↗
PubMed1996

Cerebral revascularization using omentum and serratus anterior muscle free flap transfer for adult moyamoya disease: case report.

BACKGROUND: Use of the omentum in the treatment of moyamoya disease is now widely accepted, and, especially in patients with ischemic symptoms of anterior or posterior cerebral artery distribution, omental transplantation or other indirect revascularizations are indicated. CASE REPORT: A 39-year-old man, who developed left homonymous hemianopia, was discovered to have occlusion of the distal portion of bilateral internal carotid arteries. We performed indirect revascularization with an omental flap on the left cerebral hemisphere and a serratus anterior muscle flap on the right cerebral hemisphere. RESULTS: Subsequent clinical course was uneventful. Cerebral blood flow study and angiography revealed good collateral circulation in both the omentum and muscle flap. The collateral circulation was more developed than that arising from the omental transfer on the contralateral side at the same postoperative period. CONCLUSIONS: This type of encephalomyosynangiosis (EMS)-EMS with free muscle flap-is as effective as that with the omental flap in adult moyamoya disease. Especially in a patient who is in need of vascular reconstruction of an extensive ischemic area, serratus anterior muscle flap transfer is one of the alternative methods.

Adult↗
PubMed2001

Cerebral revascularization for moyamoya disease in adults.

Moyamoya disease is a rare entity that results in progressive occlusion of the arteries of the circle of Willis. In adults, this most commonly leads to intraventricular hemorrhage and less frequently to symptoms of ischemia. Without treatment, there is progressive deterioration of neurologic function and re-hemorrhage. Direct superficial temporal artery to middle cerebral artery bypass is considered the treatment of choice, although it's efficacy, particularly for hemorrhagic disease, remains uncertain.

Adult↗
PubMed2001

Cerebral revascularization for moyamoya disease in children.

Ninety-four patients with moyamoya disease (56 in the pediatric age group and 38 adults) were treated by revascularization surgery in the past 21 years (1979--2000). Combined surgery of the superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and indirect revascularization of encaphalo-duro-arterio-myo-synangiosis (EDAMS) was performed. Ischemic attacks disappeared in most patients within 1 year (mean) after surgery in pediatric cases. No morbidity or mortality was experienced in the pediatric group. Some children with cerebral infarction before the surgery, however, had mild mental retardation even after the surgery. Early diagnosis and proper prophylactic surgical treatment is indispensable for pediatric patients with moyamoya. MR angiography is an important diagnostic modality for the screening and longitudinal follow-up of moyamoya disease.

Brain↗
PubMedDate not supplied

[The dynamic NMR tomographic picture after cerebral revascularization in patients with ischemic stroke].

The authors discuss the results of a MR tomographic examination in 12 patients with ischemic apoplexy who underwent operation for the formation of an extra-intracranial microanastomosis. It is shown that MR tomography is a valuable diagnostic method which allows visualization of the ischemic foci. It is proved that in combination with CT it yields valuable information for determining the indications for revascularization of foci of ischemia in the brain.

Adult↗
PubMed1977

Cerebral revascularization for transient ischemic attacks.

Thirty-one patients with cerebral transient ischemic, attacks and ipsilateral internal carotid artery occlusion without contralateral internal carotid artery occlusion or stenosis were treated with a surgical anastomosis between a superficial temporal artery and a cortical branch of the middle cerebral artery of the symptomatic hemisphere. The anastomosis was successful in 28 patients. Recurrent transient ischemic attacks were abolished in 23 patients and reduced in three. Two patients, one with a patent anastomosis, had strokes during the follow-up period. Of seven patients who refused the operation, two had strokes, two noted a reduction of transient ischemic attacks, two noted no change, and one became asymptomatic.

Adult↗
PubMed1990

[Indications for cerebral revascularization through the system of the external carotid artery].

The paper analyzes the study into the specific features of cerebral hemodynamics in patients with internal carotid artery occlusion. The study was performed by using Doppler ultrasound techniques. It revealed three different types of collateral blood flow of the brain according to the function of orbital anastomosis. The authors propose a new unique assessment of indications for a reconstructive operation on the external carotid artery for brain revascularization. The criteria proposed by the authors for assessing the cerebral hemodynamics enable the clear-cut indications for the above operation to be defined. The paper also summarizes the experience in examining and surgically managing 38 patients with internal carotid artery occlusion, who underwent revascularization of 39 channels of the external carotid artery.

Adult↗
PubMed1993

Cerebral revascularization with an artificial graft: long-term follow-up and discussion of the role of graft pretreatment with modified host endothelial cells.

Controversy remains regarding the effectiveness of EC/IC bypass for the prevention of stroke and the authors believe that some studies suggest that a subcategory of patients disabled by transient flow-related symptoms may benefit from surgery. The authors present a 7 1/2 year follow-up analysis of a patient who had undergone an EC/IC bypass from the proximal extracranial carotid to the middle cerebral artery using a 4 mm Gore-Tex prosthesis. Following his death from pulmonary sepsis, the graft was retrieved. Pathological and electron microscopic findings are reviewed.

Blood Vessel Prosthesis↗
PubMed1998

Cerebral revascularization using muscle free flap for ischemic cerebrovascular disease in adult patients.

The efficacy of encephalo-myo-synangiosis (EMS) using muscle free flap was evaluated for the treatment of ischemic cerebrovascular disease in adult patients. Three patients with adult moyamoya disease and three patients with atherosclerotic ischemic cerebrovascular disease were treated. EMS used four latissimus dorsi muscles and two serratus anterior muscles. Postoperative selective angiography showed collateral circulation from the transferred muscle to the brain in four of the six patients. The other two patients showed patent nutrient artery of the transferred muscle flap. Cerebral blood flow study disclosed postoperative improvement of perfusion reserve capacity in all sides. One patient suffered a perioperative stroke by hemoconcentration due to poor control of diabetes mellitus. The mean follow-up period was 23 months. EMS using muscle free flap is a possible procedure in selected patients with impaired cerebral perfusion reserve capacity due to multiple stenosis or occlusion of cerebral arteries including moyamoya disease or who required cerebral blood flow augmentation in the anterior and/or posterior cerebral artery territories due to internal carotid artery occlusion.

Adult↗
PubMed2001

Risks of stroke and current indications for cerebral revascularization in patients with carotid occlusion.

Preventing further stroke in patients with complete carotid artery occlusion remains a difficult challenge because there is no therapy proven effective for this prevention. These patients comprise approximately 15% of patients with carotid artery territory transient ischemic attacks or infarction. Patients with symptomatic carotid artery occlusion have an overall risk of subsequent stroke of 7% per year and a risk of stroke ipsilateral to the occluded carotid artery of 5.9% per year. The presence of severe hemodynamic failure demonstrated by increased oxygen extraction fraction (OEF) of the brain, in a cerebral hemisphere distal to a symptomatic occluded carotid artery, is an independent predictor of subsequent ischemic stroke with a risk comparable to that seen in medically treated patients with symptomatic severe carotid artery stenosis.

Brain↗
PubMedDate not supplied

Combined myocardial and cerebral revascularization. A ten year experience.

We report on the results of combined carotid endarterectomy and coronary artery bypass grafting in 82 patients. Vascular pathology was severe in these cases: 94% of patients had extensive multivessel coronary artery disease, 29% had unstable angina, 30% had severe left main stem stenosis and all patients had hemodynamically significant stenosis of at least one carotid artery, 13% had an additional occlusion of the contralateral internal or common carotid artery and 26% had severe bilateral carotid artery stenosis. The carotid lesion was asymptomatic in 64% of cases, 24% of the patients experienced previous transient cerebral ischemia and 12% of the patients had a history of completed stroke. Hospital mortality was 7.3%. Neurological deficit occurred in 7.3% but functional impairment was not permanent. Late results have been obtained for 76 survivors at a mean postoperative interval of 29 months. Five year life table survival rate was 86%. Follow-up showed that 3 patients (4%) have died and that 3 patients (4%) experienced a late neurologic event (one TIA; two strokes) but none of these events involved the cerebral cortex on the side of the carotid endarterectomy. The cumulative 5 year stroke free survival rate is 91%. We conclude that combined carotid endarterectomy and coronary artery bypass grafting can be done with an acceptable mortality rate in these critically ill patients and that the postoperative incidence of neurological events is low.

Adult↗
PubMed1995

Cerebral revascularization using gracilis muscle transplantation for childhood moyamoya disease.

BACKGROUND: Omental transplantation is effective in the management of ischemia in the territories of the anterior and posterior cerebral arteries in childhood moyamoya disease. We introduced a surgical revascularization using gracilis muscle transplantation to these territories. METHODS: Between January 1991 and May 1993, six children with moyamoya disease, between the age of 3 and 13 years, underwent gracilis muscle transplantation to the territory of either the anterior or the posterior cerebral artery. The mean period of follow-up after surgery was 15.2 months, with a range of 5 to 32 months. Three of the six patients had suffered from frequent transient visual disturbance and were treated with unilateral or bilateral gracilis muscle transplantation to the territory of the posterior cerebral artery. The other three patients had suffered from frequent transient paraparesis, mental retardation, and/or rectal and urinary incontinence, and were treated with gracilis muscle transplantation bilaterally to the territories of the anterior cerebral arteries. RESULTS: All three patients with gracilis muscle transplantation unilaterally or bilaterally to the occipital lobes manifested complete disappearance of their symptoms. Two of the three patients with gracilis muscle transplantation bilaterally to the frontal lobes also manifested complete disappearance of their symptoms. The remaining patient who underwent the transplantation bilaterally to the frontal lobes, continued to have episodes of transient paraparesis, postsurgically, but the frequency of symptoms was markedly decreased. CONCLUSIONS: Ischemia in the territories of the anterior and/or posterior cerebral arteries could be overcome with the use of gracilis muscle transplantation in childhood moyamoya disease.

Adolescent↗
PubMed2001

Cerebral revascularization in cranial base tumors.

Certain cranial base tumors may involve intracranial arteries by encasement or invasion. In such patients, resection of the tumor along with the involved artery is an option for treatment. Techniques and results of vascular bypasses for such lesions are discussed in this article.

Adult↗
PubMed2001

Cerebral revascularization in trauma and carotid occlusion.

Cerebrovascular disruption frequently results from head and neck trauma. Injury to the extra- and intracranial carotid artery is uncommon but is associated with a high rate of death and permanent neurologic deficit. In this article, injuries to the carotid artery are reviewed with emphasis on the mechanisms, clinical manifestations, radiologic evaluation, and management of these traumatic lesions.

Adult↗
PubMed1980

[Indications for cerebral revascularization surgery (author's transl)].

Cerebrovascular diseases are among the most widespread. In the USA alone there is at any time a population of 1.6 million people with current stroke syndrome or the sequelae thereof. The most effective weapon to combat this disease is prevention, and here reference is made in particular to surgical prevention, especially through endoarterectomy of the extracranial internal carotid, and to vertebrobasilar circulatory failure.

Brain↗