Kimura Toshikazu, Ibayashi Kenji, Kawai Kensuke
Department of Neurosurgery, Japanese Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan.
Department of Neurosurgery, Japanese Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan.
World Neurosurg. 2018 May;113:e650-e653. doi: 10.1016/j.wneu.2018.02.114. Epub 2018 Feb 28.
In superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, there is a certain risk of intraoperative acute occlusion of the bypass that can cause operative complications.
We sought to assess the efficacy of resuturing at the same site after intraoperative acute occlusion of the bypass.
In total, 129 STA-MCA anastomosis operations were performed on 125 patients at our institution. The electronic medical records of each patient were reviewed to gather information regarding intraoperative occlusion events, and the operative videos and postoperative radiologic images were also reviewed.
Twelve intraoperative acute occlusions were identified. In each case, resuturing was performed after cutting all knots, flushing the thrombus, and trimming the edges of the STAs. In 11 cases, indocyanine green videoangiography and/or Doppler sonography revealed patency during the operation, which was confirmed by postoperative magnetic resonance angiography. None of the 12 cases exhibited high-signal intensities in the MCA area on diffusion-weighted images.
If intraoperative acute occlusion of STA-MCA anastomosis occurs, reanastomosis at the site should be the first option.
在颞浅动脉-大脑中动脉（STA-MCA）吻合术中，旁路存在一定的术中急性闭塞风险，可导致手术并发症。
我们试图评估旁路术中急性闭塞后在同一部位重新缝合的疗效。
我们机构对125例患者进行了总共129例STA-MCA吻合手术。回顾了每位患者的电子病历以收集有关术中闭塞事件的信息，还回顾了手术视频和术后放射影像。
发现12例术中急性闭塞。在每种情况下，在切断所有结、冲洗血栓并修剪颞浅动脉边缘后进行重新缝合。11例在手术期间通过吲哚菁绿视频血管造影和/或多普勒超声检查显示通畅，术后磁共振血管造影证实了这一点。12例中无一例在扩散加权图像上的大脑中动脉区域表现出高信号强度。
如果发生STA-MCA吻合术中急性闭塞，应首选在该部位重新吻合。
