Shimizu Satoru, Osawa Shigeyuki, Kuroda Hiroki, Koizumi Hiroyuki, Mochizuki Takahiro, Kumabe Toshihiro
Department of Neurosurgery, Yokohama Brain and Spine Center.
Department of Neurosurgery, Kitasato University School of Medicine.
Neurol Med Chir (Tokyo). 2019 Aug 15;59(8):326-329. doi: 10.2176/nmc.tn.2018-0269. Epub 2019 Jun 5.
In cerebrovascular end-to-side anastomosis, thick, hard donor arteries overlying thin recipient arteries impair the view of the ostium, and may result in occlusion of the anastomosis. To improve the intraoperative view, we modified the stay sutures. After performing standard recipient arteriotomy and placing the first stay suture, we half-tied the second stay suture to leave a loop: half-tied stay suture (HSS). The thread of the HSS was secured with a clip to avoid slippage. For suturing side A, the clip pulling on the HSS was gently moved to the opposite side of side A, i.e. to side B, and the donor artery was revolved by several degrees to side B; the first stay suture was used as the fulcrum. Under the expanded view of the ostium, untied interrupted sutures were placed on side A. Then the donor vessel was revolved to the opposite side and side B was sutured in the same manner. At last, the HSS and all other sutures were tied fully. Our HSS method was used in three adults who underwent superficial temporal- to middle cerebral artery anastomosis despite anticipated poor visibility of the ostium. Compared with the conventional method, the view of the ostium was expanded with less manipulation of the vessel walls. There were no complications, and the anastomosis remained patent in all three patients. This simple modification of the stay sutures reduces the risk of anastomotic occlusion due to iatrogenic vascular damage by excessive manipulation under a restricted view.
在脑血管端侧吻合术中，覆盖在较细受体动脉上方的供体动脉粗大且坚硬，会影响吻合口的视野，可能导致吻合口闭塞。为改善术中视野，我们对定位缝线进行了改良。在进行标准的受体动脉切开并放置第一根定位缝线后，我们将第二根定位缝线半打结，留出一个环：半打结定位缝线（HSS）。HSS的线用夹子固定以避免滑动。缝合A侧时，拉动HSS的夹子轻轻移至A侧的对侧，即B侧，供体动脉向B侧旋转几度；以第一根定位缝线为支点。在吻合口视野扩大的情况下，在A侧放置未打结的间断缝线。然后将供体血管旋转到对侧，以同样的方式缝合B侧。最后，将HSS和所有其他缝线完全打结。尽管预计吻合口视野不佳，但我们的HSS方法应用于3例接受颞浅动脉至大脑中动脉吻合术的成人患者。与传统方法相比，通过较少的血管壁操作扩大了吻合口的视野。没有并发症发生，所有3例患者的吻合口均保持通畅。这种对定位缝线的简单改良降低了因在受限视野下过度操作导致医源性血管损伤而引起吻合口闭塞的风险。
