World Neurosurg
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Combined direct and indirect bypass have been described in the literature as a complementary technique.1 Direct superficial temporal artery-to-middle cerebral artery bypass is a cornerstone for adult moyamoya disease and syndrome as it provides immediate vascular supply.2 However, the donor vessel caliber and thus blood flow are subject to decrease over time, mainly due to new collateral formation.3 Encephaloduroarteriosynangiosis provides long-term blood supply and new collateral formation. We describe a case of progressive left internal carotid artery communicating segment atherosclerosis in a 34-year-old woman. An indirect bypass using the superficial temporal vein was chosen on the basis of absence of the left parietal branch of the superficial temporal artery.
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The superficial temporal artery to middle cerebral artery (MCA) end-to-side anastomosis is the most commonly used direct extracranial-intracranial bypasses type for Moyamoya disease (MMD). In progressive MMD without suitable scalp arteries, other bypass constructs may need to be considered to augment blood flow. ⋯ This case illustrates the need for creative bypass constructs in progressive MMD patients with multiple prior surgeries. Two surgical goals are paramount: flow augmentation with preservation of the existing collateral network to avoid complications and new deficits.
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Cerebral angiosarcoma is an extremely rare malignant tumor that originates from vascular endothelial cells of the brain or meninges. Especially, primary brainstem angiosarcoma has not been reported. ⋯ To our knowledge, this is the first case of brainstem angiosarcoma confirmed by pathology after surgical resection. This report highlights that clinicians need to consider angiosarcoma as part of the differential diagnosis for rare hemorrhagic lesions in the brainstem when both imaging findings and neurologic deterioration indicate rapid progression.