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Superficial Temporal Artery to Middle Cerebral Artery Bypass via a Minimized Approach: Operative Nuances and Problem-Solving Aspects.

Abstract：

BACKGROUND:The minimized approach for superficial temporal to middle cerebral artery (STA-MCA) bypass surgery is frequently associated with unfamiliar situations and technical problems. OBJECTIVE:Description of operative nuances and evaluation of problem-solving aspects to facilitate potential limitations related with a limited exposure approach. METHODS:In patients who underwent STA-MCA bypass surgery between February 2012 and August 2014, a preoperative high-resolution computed tomography-angiography 3-dimensional dataset was obtained to select the optimal vessels for anastomosis. Intraoperative exposure was assessed under standard neuronavigation. Anastomoses were performed with specific instruments developed by the authors. Intraoperative video documentation and follow-up records were analyzed retrospectively. RESULTS:Seventeen STA-MCA minimally invasive bypass procedures were performed on 12 patients. In all cases, the procedure could be performed through planned craniotomy (mean diameter 2.5 cm). All cases of the procedures dealt with the limitation of surgical field during bypass surgery. The described applications facilitated microsurgical handling in the environment of a limited exposure in all procedures. Follow-up showed all bypasses remained open. CONCLUSIONS:The surgical applications, operative techniques, problem-solving aspects, and development of new instruments are described. Potentially, these suggestions may enhance the surgical confidence and convenience to perform STA-MCA bypass surgery with a minimized approach.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Fischer G,Senger S,Sharif S,Oertel J

doi

10.1016/j.wneu.2015.12.029

subject

Has Abstract

pub_date

2016-04-01 00:00:00

pages

97-103

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(15)01733-7

journal_volume

88

pub_type

临床试验,杂志文章

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