Cikla Ulas, Hamilton Kimberly, Ozaydin Burak, Baskaya Mustafa K
Department of Neurological Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
Oper Neurosurg. 2019 Sep 1;17(3):E113. doi: 10.1093/ons/opy400.
The superficial temporal artery (STA) to the middle cerebral artery (MCA) bypass is the most common bypass type for revascularization to treat cerebral ischemia. If the ipsilateral STA is not available for anastomosis, various options for bypass conduits can be exercised. When the entire ipsilateral external carotid and its branches are not available, the contralateral STA may be used as a donor artery through an interposition graft. This technique is known as a "bonnet bypass." In this video, we demonstrate the utilization of a bonnet bypass in a 48-yr-old man with protein S deficiency, and right carotid artery occlusion with recurrent strokes and transient ischemic attacks (TIA). After exhausting nonsurgical options by treating with 2 antiplatelet drugs and supportive lifestyle changes, the patient continued to experience TIAs and watershed strokes in the right hemisphere. Angiography showed that the right anterior artery and the MCA were filled through the Circle of Willis, but the ipsilateral STA and entire external and common carotid arteries were not patent for potential use as a bypass donor. Since the ipsilateral bypass options were not available, we elected to perform a bypass from the contralateral STA trunk to the ipsilateral M2 with a saphenous vein interposition graft, for a so-called bonnet bypass. The patient did well after surgery and has remained symptom-free for 19 mo post bypass. The surgical technique and each step in performing this bonnet bypass are demonstrated in this 3-dimensional video. The patient consented to the publication of his operative video.
颞浅动脉（STA）至大脑中动脉（MCA）搭桥术是治疗脑缺血进行血运重建时最常用的搭桥类型。如果同侧颞浅动脉无法用于吻合，可以采用各种搭桥管道选项。当同侧颈外动脉及其分支整体不可用时，对侧颞浅动脉可通过中间移植用作供体动脉。这种技术被称为“帽状搭桥术”。在本视频中，我们展示了在一名48岁患有蛋白S缺乏症、右侧颈动脉闭塞并伴有复发性中风和短暂性脑缺血发作（TIA）的男性患者中使用帽状搭桥术的情况。在用两种抗血小板药物治疗并改变支持性生活方式用尽非手术选项后，患者仍持续出现右侧半球的短暂性脑缺血发作和分水岭脑梗死。血管造影显示右侧前动脉和大脑中动脉通过 Willis 环供血，但同侧颞浅动脉以及整个颈外动脉和颈总动脉均不畅通，无法用作潜在的搭桥供体。由于同侧没有可用的搭桥选项，我们选择通过大隐静脉中间移植，从对侧颞浅动脉主干至同侧 M2 进行搭桥，即所谓的帽状搭桥术。患者术后恢复良好，搭桥术后19个月一直无症状。本三维视频展示了帽状搭桥术的手术技术及每一步操作。患者同意公布其手术视频。
