Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan.
J Neurosurg. 2012 Aug;117(2):288-94. doi: 10.3171/2012.4.JNS111958. Epub 2012 May 25.
Superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses have continually evolved, and new strategies have been advocated for reducing anesthetic or surgical morbidity and mortality. Further simplifying, and decreasing the invasiveness of, STA-MCA bypass by performing this operation without endotracheal general anesthesia was believed to be feasible in certain subsets of patients.
The authors performed STA-MCA bypass using local anesthesia with a sedative in 10 patients with hemodynamically compromised occlusive cerebrovascular disease, as well as multiple comorbidities, between February 2010 and September 2011. The technique is based on the preoperative identification of the point at which the donor and recipient vessels are in closest proximity. Preoperative use of CT angiography allowed the authors to identify the target point precisely and use a minimally invasive procedure. All patients received dexmedetomidine as the sole sedative agent, together with scalp-blocking local anesthesia, with an unsecured airway.
Successful STA-MCA bypass surgeries were achieved via a preselected minimally invasive approach in all cases. There was good hemodynamic stability throughout surgery. No airway or ventilation complications occurred, and no patients were converted to general anesthesia. Subjectively, patients tolerated the technique well with a high rate of satisfaction. There were no perioperative morbidities or deaths. Postoperative MR angiography confirmed a patent bypass in all patients. All patients remained symptom free and returned to normal daily life following the operation.
This initial experience confirms the feasibility of performing STA-MCA bypass without endotracheal general anesthesia. This novel technique produced a high degree of patient satisfaction.
颞浅动脉（STA）-大脑中动脉（MCA）搭桥术不断发展，新的策略已被提倡用于降低麻醉或手术发病率和死亡率。通过在某些特定患者中实施无需气管内全身麻醉的操作来进一步简化和降低 STA-MCA 旁路的侵袭性，被认为是可行的。
作者于 2010 年 2 月至 2011 年 9 月，对 10 例血流动力学受损的闭塞性脑血管疾病和多种合并症患者，使用局部麻醉加镇静剂进行了 STA-MCA 旁路手术。该技术基于术前确定供体和受体血管最接近的部位。术前使用 CT 血管造影术使作者能够准确识别目标点并使用微创程序。所有患者均接受右美托咪定作为唯一的镇静剂，联合头皮阻滞局部麻醉，采用无固定气道。
所有患者均通过预先选择的微创方法成功进行了 STA-MCA 旁路手术。手术过程中血流动力学稳定良好。没有发生气道或通气并发症，也没有患者转为全身麻醉。患者主观上对该技术耐受良好，满意度高。没有围手术期并发症或死亡。术后磁共振血管造影术（MRA）证实所有患者旁路均通畅。所有患者术后均无症状，且生活恢复正常。
这一初步经验证实了在无需气管内全身麻醉的情况下进行 STA-MCA 旁路手术的可行性。这种新的技术产生了高度的患者满意度。
