A Modification of Deep-seated Bypass

Abstract

Deep-seated bypass is one of the most difficult procedures in cerebrovascular surgery. Creating an anastomosis between the superficial temporal artery (STA) and superior cerebellar artery (SCA) using a subtemporal approach is time consuming because the SCA is located deep within the ambient cistern and vein of Labbe and temporal lobe, making it difficult to achieve a wide operative field. We describe a modification of deep-seated bypass using a semi-prone park-bench position and presigmoid transtentorial approach to achieve a wide operative view without temporal lobe injury. This skull base approach may permit an STA-SCA anastomosis within 20 minutes using short forceps.