Abstract
In the field of neurosurgery today, various revascularization procedures are combined to perform surgery for such diseases as intracranial ischemic lesions, cerebral aneurysms, and brain tumors. In ischemic brain diseases, the main objective of revascularization is to save the ischemic penumbra and improve symptomatic motor paralysis and aphasia. Furthermore, blocking a parent vessel is required when hemostasis, due to a neck injury, during surgery is difficult or when the long-term prognosis for a brain aneurysm is more favorable by blocking a parent vessel; in this case, revascularization is performed to avoid brain ischemia. While revascularization procedures have mostly been established, it is generally necessary to pass a donor artery through the bone, and in a patient with an ischemic lesion, if intracranial arteriosclerosis is severe, the circulation of the entire skin may be poor, thus resulting in postoperative wound necrosis. Considering these issues, a new bypass procedure called "MMA-MCA bypass", which uses the middle meningeal artery (MMA), was investigated. Using both sides of five cadaver brains, the MMA was anastomosed with 10-0 MONOSOF as proximal as possible to the M2 of the MCA. Anastomosis was possible in all cases, and the brain was excised with the dura attached to identify the site of anastomosis to the MCA. The site of anastomosis was the M2 in seven cases, the M3 in one case, and the M4 in two cases. While it is best to perform a revascularization using an intracranial vessel, the present technique has not been previously investigated. It was procedurally possible to perform a bypass using the MMA. In the future, it will be possible to reduce the occurrence of complications by assessing blood flow volume and performing this bypass in clinical settings.
