Treatment of Cases with Chronic Cerebral Ischemia: Extra-Intracranial Microvascular Anastomoses

V.A. Lukshin, D.Yu. Usachev, A.V. Shmigelskiy, A.Yu. Belyaev, A.D. Sosnin, A.D. Ahmedov

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

Material and Methods. We performed 168 operations, aimed at creation of extra-intracranial microvascular anastomoses (EICMA). There were 159 cases with ICA (154) and MCA (6) occlusion. Their age varied from 14 up to 72 years (mean age 52 years). A total number of microvascular anastomoses was 168. They were applied between branches of a superficial temporal artery (parietal 146 cases, frontal 22 cases) and MCA branches (cortical branches (M4) 165 cases, M3 segment 2 cases, M2 segment 1 case). Blood flow in donor and recipient arteries, as well as blood flow direction in a recipient artery, were estimated intraoperatively. Anastomosis was applied at an angle of 450 in relation to a donor artery. Its direction (proximal or distal) was determined on the basis of data of intraoperative fluorometry (volumetric blood flow in donor and recipient arteries). Doppler examination was used in all the cases in order to confirm functioning of anastomosis.

Results. Regression of signs of cerebral ischemia was watched in the majority of cases (75%). There were no changes in 22% of cases. Augmentation of neurological deficit was observed in 3 cases (1.8%). It was likely to be a sequela of intraoperative ischemia. The mortality rate was 1.2%. There were two cases, who were subjected to anastomosing in an acute period of ischemic stroke (stroke in a process of development). A follow-up was indicative of good functioning of EICMA in the majority of cases. Volumetric blood flow varied from 21 up to 125 ml/min (a median of 38 ml/min). EICMA thrombosis was present in 5 cases (3%). There were 4 cases (2.4%) with trophic and necrotic changes of a skin graft, which developed in a delayed period.