• Br J Neurosurg · Dec 2020

    Reversal of the reversed 'Robin Hood syndrome' after superficial temporal-Middle cerebral artery bypass for severe intracranial stenosis.

    • Vijay K Sharma, Ning Chou, and Arvind K Sinha.
    • Division of Neurology, National University Health System, Singapore, Singapore.
    • Br J Neurosurg. 2020 Dec 1; 34 (6): 626-627.

    AbstractBackground: Intracranial arterial stenosis is a common cause of ischemic stroke. Recent attempts with intracranial stenting and superficial temporal-middle cerebral artery (STA-MCA) bypass failed to show benefit. Perhaps, better strategies are needed for selecting suitable patients. Acetazolamide-challenged single photon emission computed tomography (SPECT) can demonstrate reversed Robin Hood syndrome (RRHS) due to intracranial steal phenomenon and identify high-risk patients.Methods: We describe the clinical and SPECT findings of RRHS.Results: In our patient with severe and symptomatic severe stenosis of the right MCA, STA-MCA bypass resulted in complete resolution of RRHS.Conclusion: STA-MCA bypass surgery should be considered a possible option in patients with severe stenosis of intracranial internal carotid artery or MCA in carefully selected patients.

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