Less invasive technique for EC-IC bypass

We introduce less invasive technique for superficial temporal to middle cerebral artery (STA-MCA) anastomosis, and also described an innovative technique to preoperatively identify the recipient artery using three dimensional CT angiography (3D CTA). Objective. In a period of 28 months between January 2004 and April 2006, 39 EC-IC bypass were performed for hemodynamic compromised patients (including 9 patients with Moyamoya disease) using less invasive technique.

Operative technique is as follows: 1) A parietal or frontal branch of STA and cortical arteries could be identified on the original images of 3D CTA. The most suitable segment of both the artery provided as donor and recipient arteries for EC-IC bypass. The distance between the afore-mentioned segment of donor artery (STA) and the superior border of the helix were calculated. 2) A 5 cm linear skin incision on the STA, the center of which was the point measured on preoperative 3D CTA, was made. The temporal muscle was divided in the same fashion, and a 3 cm small craniotomy was made. The recipient artery could be identified on the center of the craniotomy. End-to-side anastomosis was performed in the usual way.

Operation times were 115-172 min (mean 154 min) and intraoperative blood loss was 20-60 ml (mean 38 ml). All bypasses were patent on the post-operative 3D CTA.

This technique for EC-IC bypass was less invasive and cosmetically excellent. 3D CTA provides useful information for planning of the less invasive EC-IC bypass.