Reversal of intracerebral steal by STA-MCA anastomosis

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✓ A major factor determining the severity of neurological deficits caused by cerebral ischemia is the ability of the vasculature to provide collateral circulation to the ischemic areas. By establishing a major conduit by means of extracranial-intracranial anastomosis, the increased perfusion pressure through the collateral arterioles may reduce morbidity in these patients. Twenty-seven patients were selected for superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis based on clinical and angiographic evidence of lesions of the internal carotid arterial system. Cerebral blood flows (CBF's) were determined by the xenon-133 inhalation method using 16 symmetrically placed scintillator probes; two-compartment analysis was used to compute a mean flow for the compartment. An average mean flow was computed for each hemisphere, and for four regions with the lowest mean CBF in each hemisphere. The CBF was measured preoperatively and within 8 weeks postoperatively.

The average mean flow was 29 ml/100 gm/min in the symptomatic hemisphere, and 30 ml/100 gm/min in the asymptomatic hemisphere. In 11 patients, the mean flow for the symptomatic hemisphere increased by 24% postoperatively, and for the asymptomatic hemisphere by 23%. Regions with lowest CBF showed an increase of 32% in the symptomatic hemisphere, and of 35% in the asymptomatic hemisphere. The low-flow regions differed from the total hemisphere (symptomatic: p < 0.02; asymptomatic: p < 0.05). Areas of lowest blood flow preoperatively had the greatest increase in flow postoperatively. Postoperative elevation of CBF in the contralateral hemisphere is consistent with an “intracerebral steal” before surgery. The postoperative elevation of flow in the asymptomatic hemisphere is related to improved perfusion pressure in the symptomatic hemisphere.

Article Information

Address for Dr. Lawner: Division of Neurosurgery, Harbor/UCLA Medical Center, Torrance, California.

Address for Dr. O'Connor: Division of Neurosurgery, Graduate Hospital, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.

Address reprint requests to: John P. Laurent, M.D., Department of Neurosurgery, Texas Children's Hospital, Suite O-202, Houston, Texas 77030.

© AANS, except where prohibited by US copyright law.

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    Layout of the array of scintillator counters over the hemispheres. The even numbers represent the right hemisphere; the odd numbers the left hemisphere. Note the concentration of counters over the motor and sensory portion of the hemisphere. Anterior cerebral artery flows (1, 9; 2, 11) increased 40%, middle cerebral artery flows (5, 13; 8, 16; 3, 10; 7, 14) increased 15%, and watershed zones increased 85% in both hemispheres following superficial temporal artery to middle cerebral artery anastomosis in this series of patients.

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