Emergency Superficial Temporal Artery–Superior Cerebellar Artery Bypass for the Refractory Vertebrobasilar Insufficiency with Partial Mastoidectomy

Although it is well-known that vertebrobasilar insufficiency (VBI) because of atherothrombosis with bilateral vertebral artery (VA) occlusion is resistant to medical treatment from the acute to subacute stages, the most appropriate treatment for progressive infarction at these stages remains unclear. Here, we described a patient with VBI who underwent emergency superficial temporal artery–superior cerebellar artery (STA–SCA) bypass under partial mastoidectomy after confirming mismatch between diffusion-weighted imaging (DWI) findings and clinical symptoms. The patient showed a good outcome with this approach. To our knowledge, our surgical strategy has not been previously reported. The patient was a 71-year-old woman with progressive infarction because of atherothrombosis with bilateral VA occlusions resistant to maximum medical treatment. Emergency STA–SCA bypass under partial mastoidectomy was performed after confirming DWI findings and symptom mismatch. A good outcome was archived, and no additional cerebral infarctions were noted. Emergency bypass should be considered as a treatment option for VBI that is resistant to maximal medical treatment after confirming DWI findings and symptom mismatch. Our approach involving partial mastoidectomy provides a wide and shallow operative field for STA–SCA bypass, which allows accurate bypass with good outcomes. •The refractory vertebrobasilar insufficiency are well known to bring poor outcomes.•The refractory VBI are considered the indication for emergency STA-SCA bypass under referencing DWI-symptomatic mismatch.•The anastomosis field for STA-SCA bypass under partial mastoidectomy is required the wide and shallow anastomotic field.