慢性期脳虚血性病変に対して安全確実にSTA-MCAバイパス術を完遂するための外科的治療戦略

抄録

Extracranial-intracranial (EC-IC) bypass is one of the most fundamental techniques for cerebrovascular surgery. We describe our surgical results and strategy for performing the EC-IC bypass safely and precisely in patients with chronic stage ischemia. Surgical indications were decided for symptomatic internal carotid or middle cerebral artery occlusive disease with misery perfusion detected using quantitative single-photon emission computed tomography. Antiplatelet medications were continued, and intravenous hyperosmotic colloid infusion was started 1 week before operation. Target recipient M4 arteries were superimposed on the superficial temporal artery and cranial bone. Preparation of the superficial temporal artery was performed by using an ultrasound instrument (Harmonic Scalpel^®). The craniotomy site was located under the supratemporal line. Various anastomotic techniques were adopted, including continuous, running, and intermittent suturing methods. The second target recipient artery was confirmed using intra-arterial indocyanine green videoangiography. Hyperbaric oxygen therapy was performed for wound problems. Forty patients (43 sides) underwent EC-IC bypass between September 2010 and March 2015 (mean age, 64.5 years; 28 men and 12 women; double bypass in 35 patients and single bypass in eight). Postoperative complications were chronic subdural hematomas and skin problems in five patients each. None of the patients had permanent deficit. Well-drained operative field and steady hand movements are necessary to perform safe and secure bypass procedures. The various technical tips and surgical strategies that we have suggested can contribute to improving surgical results.