{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T21:24:25Z","timestamp":1772227465409,"version":"3.50.1"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1991,12]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 The surgical management of an emerging clinical entity, namely disabling transient cerebral ischemic attacks, is described. A series of 19 patients treated in a 2-year period (12 with anterior circulation dysfunction and seven with posterior insufficiency) met the following criteria: 1) stereotypical recurrent episodes of transient neurological dysfunction related to the anterior or posterior circulation distribution; 2) failure of maximum medical therapy to control the transient neurological dysfunction; 3) four-vessel cerebral angiography demonstrating an isolated vascular territory corresponding to patient symptoms; 4) inhalation xenon cerebral blood flow studies with at least three of eight probe-pairs showing significant asymmetries in the initial slope index, localizing an area of relative oligemia to the symptomatic hemisphere (anterior circulation only); and 5) severe restriction of lifestyle due to transient ischemic attacks (TIA's). Seventeen patients underwent surgical bypass therapy: deep sylvian superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in nine; surface STA-MCA bypass in three: STA-superior cerebellar artery bypass in three; STA-posterior cerebral artery bypass in one; and aorta-carotid artery bypass in one. There was one perioperative death and four perioperative strokes (two ipsilateral and two contralateral to the operated side). The average follow-up period was 14 months. Of the 16 surviving surgically treated patients, 13 (81%) have had an excellent to good outcome with complete resolution of TIA's and minimal neurological deficits. Three patients had a poor outcome with either a significant persistent neurological deficit or continued TIA's. The two patients not treated surgically continue to have vertebrobasilar insufficiency episodes while receiving oral anticoagulation medication. The overall mortality rate (5.5%) and stroke morbidity rate (22.2%) of surgical therapy for disabling TIA's are high in this neurologically unstable group of patients, but are associated with an 81 % excellent to good response.<\/jats:p>\n<jats:p content-type=\"fine-print\">Although the natural history of disabling TIA's is not known, these patients present with significant to total disability due to their symptoms. It is concluded that disabling TIA's respond to surgical revascularization and may represent an indication for cerebral revascularization surgery.<\/jats:p>","DOI":"10.3171\/jns.1991.75.6.0891","type":"journal-article","created":{"date-parts":[[2009,5,19]],"date-time":"2009-05-19T16:25:34Z","timestamp":1242750334000},"page":"891-901","source":"Crossref","is-referenced-by-count":16,"title":["Disabling cerebral transient ischemic attacks"],"prefix":"10.3171","volume":"75","author":[{"given":"Patrick W.","family":"McCormick","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J.","family":"Tomecek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean","family":"McKinney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James I.","family":"Ausman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Surg Neurol","first-page":"218","article-title":"Critique of the extracranial-intracranial bypass study.","volume":"26","author":"Ausman","year":"1986"},{"key":"b2","series-title":"J Neurosurg","first-page":"766","article-title":"Posterior circulation revascularization. Superficial temporal artery to superior cerebellar artery anastomosis.","volume":"56","author":"Ausman","year":"1982"},{"key":"b3","series-title":"Operative Neurosurgical Techniques. Indications, Methods and Results","first-page":"807","article-title":"Posterior fossa revascularization","volume":"1","author":"Ausman","year":"1988"},{"key":"b4","series-title":"J Neurosurg","first-page":"554","article-title":"Superficial temporal and occipital artery bypass pedicles to superior, anterior inferior, and posterior inferior cerebellar arteries for vertebrobasilar insufficiency.","volume":"72","author":"Ausman","year":"1990"},{"key":"b5","series-title":"Brain","first-page":"231","article-title":"Internal carotid artery occlusion. A study of 61 instances in 50 patients with post-mortem data.","volume":"93","author":"Castaigne","year":"1970"},{"key":"b6","series-title":"Surg Neurol","first-page":"222","article-title":"The extracranial-intracranial bypass study.","volume":"26","author":"Day","year":"1986"},{"key":"b7","series-title":"J Neurosurg","first-page":"21","article-title":"Cerebral revascularization to a main limb of the middle cerebral artery in the Sylvian fissure. An alternative approach to conventional anastomosis.","volume":"63","author":"Diaz","year":"1985"},{"key":"b8","series-title":"N Engl J Med","first-page":"1191","article-title":"Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial.","volume":"313","year":"1985"},{"key":"b9","series-title":"Stroke","first-page":"397","article-title":"The international cooperative study of extracranial\/intracranial arterial anastomosis (EC\/IC bypass study): methodology and entry characteristics.","volume":"16","year":"1985"},{"key":"b10","series-title":"Cerebral Blood Flow. Physiologic and Clinical Aspects.","first-page":"202","article-title":"133Xenon inhalation: accuracy in detection of ischemic cerebral regions and angiographic lesions","author":"Ewing","year":"1987"},{"key":"b11","series-title":"J Cereb Blood Flow Metab (Suppl)","first-page":"586","article-title":"A probe by probe identification of focal cerebral ischemia using the (133)Xenon inhalation technique.","volume":"3","author":"Ewing","year":"1983"},{"key":"b12","series-title":"N Engl J Med","first-page":"1505","article-title":"Current medical and surgical therapy for cerebrovascular disease.","volume":"317","author":"Grotta","year":"1987"},{"key":"b13","series-title":"Cerebral Revascularization for Stroke.","first-page":"490","article-title":"A rational surgical approach to vertebrobasilar ischemia","author":"Hopkins","year":"1985"},{"key":"b14","series-title":"Stroke","first-page":"52","article-title":"Pathogenesis of cerebral infarction secondary to mechanical carotid artery occlusion.","volume":"1","author":"Landolt","year":"1970"},{"key":"b15","series-title":"Arch Intern Med","first-page":"90","article-title":"Acute cerebral ischemia in a critical care unit. A review of diagnosis and management.","volume":"149","author":"Levine","year":"1989"},{"key":"b16","series-title":"Stroke","first-page":"565","article-title":"A classification and outline of cerebrovascular disease II.","volume":"6","author":"Millikan","year":"1975"},{"key":"b17","series-title":"J Vasc Surg","first-page":"542","article-title":"Neurologic sequelae of unilateral carotid artery occlusion: immediate and late.","volume":"10","author":"Nicholls","year":"1989"},{"key":"b18","series-title":"J Neurosurg","first-page":"61","article-title":"Clinical results of extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular disease.","volume":"70","author":"Powers","year":"1989"},{"key":"b19","series-title":"Curr Ther Neurol Surg","first-page":"147","article-title":"Reconstructive vascular surgery.","volume":"2","author":"Sadasivan","year":"1989"},{"key":"b20","series-title":"Mayo Clin Proc","first-page":"301","article-title":"Carotid endarterectomy. Complications and preoperative assessment of risk.","volume":"50","author":"Sundt","year":"1975"},{"key":"b21","series-title":"Stroke","first-page":"637","article-title":"Classification of cerebrovascular disease III. Special report from the National Institute of Neurological Disorders and Stroke.","volume":"21","author":"Whisnant","year":"1990"},{"key":"b22","series-title":"Mayo Clin Proc","first-page":"171","article-title":"Carotid endarterectomy for unilateral carotid system transient cerebral ischemia.","volume":"58","author":"Whisnant","year":"1983"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/75\/6\/article-p891.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/75\/6\/article-p891.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/75\/6\/article-p891.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,19]],"date-time":"2023-03-19T22:39:08Z","timestamp":1679265548000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/75\/6\/article-p891.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1991,12]]},"references-count":22,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/jns.1991.75.6.0891","relation":{},"ISSN":["0022-3085"],"issn-type":[{"value":"0022-3085","type":"print"}],"subject":[],"published":{"date-parts":[[1991,12]]}}}