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Less invasive technique for EC-IC bypass.

Y Kaku¹, H Watarai, J Kokuzawa

¹Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan. kaku@murakami.asahi-u.ac.jp

Acta Neurochirurgica. Supplement

|May 24, 2008

Summary

A new, less invasive superficial temporal to middle cerebral artery (STA-MCA) bypass technique, aided by 3D CT angiography, offers cosmetic benefits and successful arterial anastomosis for patients with hemodynamic compromise.

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Area of Science:

Neurosurgery
Vascular Surgery
Medical Imaging

Background:

A less invasive technique for superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis is introduced.
Preoperative identification of the recipient artery using 3D CT angiography (3D CTA) is described.
39 EC-IC bypasses were performed for hemodynamic compromised patients, including 9 with Moyamoya disease.

Purpose of the Study:

To present a novel, less invasive surgical approach for STA-MCA anastomosis.
To highlight the utility of 3D CTA in planning minimally invasive EC-IC bypass procedures.
To evaluate the efficacy and safety of this technique in patients with hemodynamic compromise.

Main Methods:

Preoperative 3D CTA was used to identify suitable donor (STA) and recipient arteries and measure distances.

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A small skin incision (5 cm) over the STA was made, followed by muscle division and a small craniotomy (3 cm).

End-to-side anastomosis was performed in the standard manner after identifying the recipient artery within the craniotomy.

Main Results:

Surgical times averaged 154 minutes (range 115-172 min) with minimal blood loss (mean 38 ml, range 20-60 ml).
Postoperative 3D CTA confirmed the patency of all performed bypasses.
The technique proved to be less invasive and cosmetically superior.

Conclusions:

The described technique offers a less invasive and cosmetically advantageous approach for EC-IC bypass.
3D CTA is a valuable tool for preoperative planning, enabling minimally invasive EC-IC bypass surgery.
This method is effective for treating patients requiring EC-IC bypass due to hemodynamic compromise.