Abstract
Complex cerebral aneurysm and hemodynamic occlusive cerebrovascular disease require microvascular-anastomosis, mainly superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, as treatment tactics. Preparing a clean, well-drained operative field with a platform for placing microvascular sutures, good visualization of the arteriotomy, and steady hand movements are necessary to achieve a safe and secure bypass procedure. We present representative troubles that may be encountered in STA-MCA bypass surgery and describe how to manage those troubles. We stress that patients whose bypass appears to occlude immediately after surgery are sometimes encountered, because of problems in the STA itself such as spasm, dissection, distortion or pinching by surrounding tissues.
