A Needle Tip Quality-Controlled Training Protocol for Cerebrovascular End-to-Side Bypass: From Bench to Bedside

Improper techniques in cerebrovascular end-to-side bypass, such as back-wall injury or skiving bites, can lead to stenosis or thrombosis. To address this challenge, we developed a needle tip quality-controlled (TQC) training protocol and evaluated its training value and clinical significance.

The TQC protocol mandates continuous visualization of the needle tip within the vessel lumen during each stitch, guided by strict suturing principles that prohibit intraluminal blind suturing. An attending neurosurgeon underwent training using the TQC protocol on a rat femoral vessel model before its clinical application in 26 bypass cases. Cumulative sum analysis was used to assess recipient clamp times during both the animal training and clinical surgeries. Intraoperative and postoperative bypass patency rates were also evaluated.

In the 24 animal models, the mean recipient clamp time was 30.79 ± 6.42 minutes. Cumulative sum analysis revealed that proficiency required 16 models, after which clamp times significantly decreased to 27.37 ± 5.15 minutes (P = .013; mean difference 8.88 minutes, 95% CI, 2.18-15.57). No back-wall injuries or skiving bites were observed, and the delayed patency rate was 95.83%. In the 26 superficial temporal artery to middle cerebral artery bypass cases, the mean recipient clamp time was 26.65 ± 6.16 minutes, with the mastery phase achieved after 6 cases. The intraoperative and 3-month postoperative patency rates were 100% and 96.15%, respectively.

The TQC protocol effectively prevents technical errors, ensuring high-quality anastomosis. Its high trainability and short learning curve establish it as a practical and valuable training tool for young vascular neurosurgeons.