PMC9062919_01
Upper part: magnetic resonance angiography (MRA). Before surgery: MRA showing the occlusion of the right middle cerebral artery (MCA).
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F1
When the patient visited our hospital, MRA revealed the right MCA occlusion [Figures 1 and 2].
Angiography showing almost complete occlusion of the right horizontal segment of the middle cerebral artery and development of collateral circulation through pial anastomosis from the anterior cerebral artery.
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F2
When the patient visited our hospital, MRA revealed the right MCA occlusion [Figures 1 and 2]. Digital subtraction angiography revealed almost complete occlusion of the right horizontal segment of the MCA as well as collateral circulation through the pial anastomosis from the anterior cerebral artery [Figure 2].
(a) Region of interest for cerebral blood flow measurement using perfusion computed tomography. Comparison of the average cerebral blood flow in (2), (3), (4), and (5) (left MCA territory) with that in (8), (9), (10), and (11) (right MCA territory). (b) Region of interest for blood flow measurement in the basal ganglia through perfusion computed tomography. Tracing of the basal ganglia and comparison of the blood flow on the left and right sides.
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F3
In this case, we obtained the ratio of the right CBF to the left CBF in four regions, excluding the frontal and occipital regions [Figure 3a]. In addition, we examined the laterality of blood flow in the basal ganglia [Figure 3b].
Perfusion computed tomography findings.
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F4
Perfusion CT revealed that the CBF on the right side was 64% and 94% of that on the left side in the cortical areas and basal ganglia, respectively [Figure 4].
Intraoperative photographs. ICG: Indocyanine green.
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F5
We performed superficial temporal artery (STA)-MCA bypass surgery because we believed that the dystonia was due to right MCA stenosis [Figure 5].
Six months after bypass surgery: the MCA with the intact bypass. Lower part: perfusion computed tomography.
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F6
The right MCA was assessed using MRA 6 months after the operation [Figure 6].