医学
开颅术
大脑中动脉
剪裁(形态学)
颞浅动脉
吻合
外科
动脉瘤
闭塞
大脑前动脉
麻醉
缺血
心脏病学
语言学
哲学
作者
Taichi Ishiguro,Akitsugu Kawashima,Shunsuke Nomura,Behnam Rezai Jahromi,Hugo Andrade-Barazarte,Juha Hernesniemi,Takakazu Kawamata
标识
DOI:10.1016/j.clineuro.2023.107775
摘要
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.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.Anastomosis was successful in all patients. Despite requiring temporary occlusion of the parent artery, all aneurysms were successfully clipped without any neurological deterioration.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.
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