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  • The superficial temporal to middle cerebral artery bypass : recipe for success!

    Final Number:
    4142

    Authors:
    Shashwat Mishra MCh

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting - Late Breaking Science

    Introduction: The results of the EC-IC randomized trial (NEJM,1985) and the COSS (JAMA, 2006) severely shrunk the indications for STA to MCA bypass. The resultant decline in surgical volumes was paralleled by an erosion of the skills necessary for executing this surgery. Hence, this paper, drawing upon the personal experience of the surgeon, is an attempt to sum up the surgical nuances necessary for the satisfactory execution of this surgery and would benefit the initiate who takes up this delicate operation.

    Methods: 12 STA- MCA anastomoses were performed in 8 patients over a two year period between May 2015 – May 2017 by the author. All except one patient had Moya-Moya disease. 4 subjects were below 18 years of age and the rest were adults.

    Results: At follow –up angiogram (CT/DSA) ,8 bypasses were functional. Clinical improvement was reported in 8 patients following surgery. The surgical time for completion of bypass declined from an average of 380 minutes to 240 minutes with growing experience. Demonstration of bypass patency by a delayed indocynanine green angiography was predictive of long term bypass patency. Meticulous preparation of the vessel segments to be coapted, an intelligent and ergonomic arrangement of surgical field with gelatin sponges, short suture lengths and use of platformed jewelers forceps were some of the important surgical nuances .

    Conclusions: For the initiate, adherence to the critical surgical nuances described in this paper greatly increases the surgeon’s efficiency and the possibility of success for the STA- MCA bypass operation.

    Patient Care: It will help the surgeons, having limited experience with this operation, in approaching this procedure with greater confidence and possibility of success.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognise the essentials of atraumatic harvesting of the STA graft 2) Understand the essentials of preparation of the operative field for microanastomosis 3) Appreciate the common errors which might frustrate the inexperienced neurosurgeon attempting this operation

    References:

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