Application of protective superficial temporal artery to middle cerebral artery bypass through the lateral supraorbital approach: Technical note.

Autor: Ishiguro T; Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan., Kawashima A; Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan. Electronic address: kawashima18surg@yahoo.co.jp., Nomura S; Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan., Jahromi BR; Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Andrade-Barazarte H; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada., Hernesniemi JA; Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China., Kawamata T; Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Clinical neurology and neurosurgery [Clin Neurol Neurosurg] 2023 Jul; Vol. 230, pp. 107775. Date of Electronic Publication: 2023 May 11.
DOI: 10.1016/j.clineuro.2023.107775
Abstrakt: Objective: The lateral supraorbital (LSO) approach is a minimally invasive craniotomy widely used in the surgical treatment of intracranial aneurysms (IAs). A protective bypass is considered a safety measure in high-risk and complex clipping procedures to maintain distal cerebral flow. However, the protective bypass has so far only been applied through a pterional or larger craniotomy. We aimed to describe the characteristics of the superficial temporal artery to middle cerebral artery (STA-MCA) bypass through the LSO craniotomy to treat complex IAs.
Methods: We retrospectively identified six patients with complex IAs who underwent clipping and a protective STA-MCA bypass through the LSO approach between January 2016 and December 2020. The STA donor artery was harvested through the same curvilinear skin incision with a small extension, and it was anastomosed to the opercular segment of the MCA. Subsequently, aneurysm clipping followed standardized steps.
Results: Anastomosis was successful in all patients. Despite requiring temporary occlusion of the parent artery, all aneurysms were successfully clipped without any neurological deterioration.
Conclusions: A protective STA-MCA bypass is feasible through the LSO approach with certain technical modifications. This technique helps protect distal cerebral flow for safe clip placement in the treatment of complex IAs with the associated benefits of a less invasive craniotomy.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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