[Superficial temporal to proximal superior cerebellar artery anastomosis for brain stem ischemia. Case report].

Occipital artery posterior inferior cerebellar artery anastomosis seems to be less effective for ischemia of the rostral brain stem. The authors performed superficial temporal artery superior cerebellar artery (STA-SCA) anastomosis for the rostral brain stem ischemia with excellent results. The patient, a 52-year-old female, was admitted because of vertigo and fainting attacks induced by turning the head to the left. She had been on antiplatelet therapy with the stellate ganglion block without improvement. Cerebral angiography revealed severe stenosis of the right vertebral artery in the proximal portion, complete obstruction of the left vertebral artery at its origin, no significant col lateral circulation to the upper basilar artery through posterior communicating artery, and stenosis of bilateral internal carotid arteries in the cervical and siphonic portions. Regional cerebral blood flow study by 133Xe showed decreas d blood flow in the bilateral occipital lobes. The STA-SCA anastomosis was performed through the subtemporal approach with spinal drainage and intra venous mannitol administration. Postoperatively, the vertigo and fainting attacks disappeared. However, transient sensory aphasia was noted along with a intracerebral hematoma of the temporal lobe. Postoperative cerebral angiography demonstrated excellent visualization of the bilateral superior cerebellar arteries and the 133Xe study showed improvement of the occipital blood flow.