Anastamosis for Brain Stem

Eight years ago a 64-year-old diabetic man began having one or two minute attacks of lightheadedness, vertigo, blurred vision and occasional paresthesia in both sides of the face and the lips. Two years prior to admission, he had had one episode of vision loss in the left eye for 20 to 30 seconds. The neurological examination on admission showed normal limits. The cerebral angiograms revealed: a) occlusion of the right vertebral artery; b) occlusion of the left vertebral artery and its distal reconstitution through the muscular branches; c) minimal irregularities of the cervical portion of the internal carotid artery on the right; and d) a very irregular and markedly narrowed left internal carotid artery within the cavernous sinus (figs. 2a, 2b, 2c, 2d). He first underwent a left superficial temporal-middle cerebral artery anastomosis. Angiograms two weeks later showed a patent anastomosis (figs. 3a, 3b). While waiting at home to have an OA-Caudal Loop-PICA anastomosis for symptoms of posterior circulation insufficiency, he showed further deterioration characterized by difficulty in swallowing and articulation and involuntary right face movements. Therefore, after immediate readmission, he underwent a right OA-Left Caudal Loop-PICA anastomosis. A day after surgery, the patient's dysarthria had improved and he no longer had dysphagia or facial movements. A right brachial angiogram ten days postoperatively revealed a patent anastomosis (figs. 4a, 4b, 4c, 4d). On discharge, the patient had no neurological abnormality except for mild dysarthria. Seven months after operation he showed no speech abnormality.