middle meningeal artery-middle cerebral artery anastomosis

In 1979, Miller and Nishikawa reported the use of the middle meningeal artery instead of the superficial temporal artery and the middle cerebral artery to treat cerebral ischemia caused by proximal stenosis and occlusion of the internal carotid artery or middle cerebral artery. The middle meningeal artery is a branch of the external carotid artery, which enters the skull from the spine of the skull base and is divided into the frontal branch and the apical branch. Usually, the amount of the forehead is relatively large, and it travels along the big wing of the sphenoid bone, and its path is equivalent to the position of the center of the brain. The path of the top branch corresponds to the position of the temporal and angular back. In the site where the intracranial and external arteries can be anastomosed, the diameter of the middle meningeal artery is about 2/3 of the superficial temporal artery, with an average of 1.1 mm. When the superficial temporal artery-brain artery anastomosis is needed, but the superficial temporal artery or occipital artery cannot be used as the blood supply artery, the branch of the middle meningeal artery and the middle cerebral artery can be used to provide collateral blood supply to the brain. . Treatment of diseases: internal carotid artery occlusion after trauma Indication 1. Extracranial surgery "can not reach" the internal carotid artery occlusion or stenosis, and due to insufficient collateral circulation and cerebral ischemia symptoms. 2. The middle cerebral artery stenosis or occlusion, cerebral ischemia symptoms due to insufficient collateral circulation. 3. Diffuse hypoperfusion syndrome: due to extracranial surgery "can not be achieved" multiple cerebral artery stenosis or occlusion, causing mental retardation, syncope, ataxia, orthostatic ischemic attack and other symptoms. Contraindications 1. Older patients, with severe systemic diseases such as lung, heart, kidney, liver disease, diabetes, etc. 2. There are already serious and persistent neurological dysfunctions. 3. Although there is stenosis or occlusion of the internal carotid artery or middle cerebral artery, but no neurological symptoms, cerebral blood flow (CBF) is also normal, indicating that the collateral circulation is sufficient. 4. There is extensive cerebral infarction in the blood supply area or inner capsule of the middle cerebral artery. It is estimated that even if the anastomosis is successful, it is difficult to improve the symptoms. Preoperative preparation 1. Adequate cerebral angiography, including bilateral carotid angiography and at least one side of vertebral angiography, should be comprehensively understood for cerebral vascular stenosis and collateral circulation. 2. CT scan to determine the presence and extent of cerebral infarction. 3. Determination of cerebral blood flow. 4. Prepare the scalp as usual. 5. Give preventive antibiotics. Surgical procedure Incision A horseshoe-shaped incision in the frontal forehead. 2. Craniotomy The frontal iliac crest is craniotomy. Be careful not to injure the underlying dural artery when opening the bone flap. After the trunk of the artery enters the cranium, it is trapped in the middle meningeal sulcus of the intraosseous plate on the outside of the sphenoid ridge, and some is the bone tube. The artery passes through it and is easily torn when the flap is turned. 3. Anastomotic artery The dura mater was cut at 0.5 cm from both sides of the selected middle meningeal artery. The middle meningeal artery was included in the 1 cm wide dura mater. The arterial clip was used to temporarily clamp the artery, the distal end was cut, and the dural incision was made. Hemorrhage was carefully stopped by bipolar coagulation. The dura mater is cut along the bone window, and the branch of the middle cerebral artery is searched for as a blood-sucking artery at the middle of the meningeal artery. A section of about 1 cm in length was separated and a rubber membrane was placed underneath it to separate it from the cerebral cortex. A midbrain artery with a length of about 5 to 7 mm was peeled off from the meninges of the meninges, and a lateral membrane of 2 to 3 mm in length at the end of the artery was peeled off, and the end was cut into a slope to enlarge its caliber. End-to-side anastomosis was performed with a 11-0 single-strand nylon line with the middle cerebral artery. The anastomosis was the same as that of the superficial temporal artery-brain artery. The dura mater at the defect is repaired with a periosteum or tendon fascia. 4. Guan skull.

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