Tips for Secure Anastomosis and Patency in Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery

Abstract

The superficial temporal artery to middle cerebral artery (STA-MCA) bypass is an effective surgical option to treat stenosis of the intra-or extra-cranial arteries. However, anastomosis of narrow arteries is a technically difficult procedure. Indeed, several complications including a damaged vessel during surgery have been reported. Here, we describe a successful arterial anastomosis during the STA-MCA bypass surgery. This approach comprised three steps. First, the cut end of the STA is prepared so that a neurosurgeon can easily keep the STA lumen open during anastomosis. Second, a sterile gelatin sponge is used to prevent flooding of spinal fluid. Third, sequential order of suturing in anastomosis of the STA and MCA is crucial. Combination of these tips provides an easy, fast, and solid approach, resulting in a secure anastomosis and at least one year of patency in 19 out of 20 cases.