2018 Volume 46 Issue 4 Pages 254-261
Superficial temporal artery-middle cerebral artery (STA-MCA) bypass is a fundamental neurosurgery and a highly versatile technique. Off-the-job training has already been widely permeated, and even young surgeons can learn this surgical skill through training.
However, there are various difficulties in STA-MCA bypass surgery. To perform a successful surgery without complications, it is important for the surgeon to update their surgical skills and techniques, receive surgical instructions as an assistant, and to have various experiences that will allow him to be able to handle surgical complications later.
In this article, we describe important points from a more detailed viewpoint using photos and schemas on how to avoid complications beforehand and perform successful STA-MCA bypass surgery.
In STA-MCA bypass surgery, to avoid complications, it is important to take care of the following: (1) ensuring an optimal operating field, (2) gentle handling of blood vessels, (3) proper suturing.
To ensure an optimal operating field, an environment for proper suturing in a bloodless and semi-wet condition is essential. For gentle handling of blood vessels, attention should be paid to manipulation of the recipient/donor artery, processing method of small arterial branches, and handling method of the suturing needle. For proper suturing, attention should be paid to prevent suturing the opposite side, for suturing to adhere each inner membrane, and proper thread knotting, such as the Square knot.