Hendricks Benjamin K, Spetzler Robert F
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Oper Neurosurg. 2020 Jun 1;18(6):E229. doi: 10.1093/ons/opaa039.
The most frequently performed low-flow bypass procedure is the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass. If available, a suitable M2 or M3 cortical branch is anastomosed to the donor vessel. This patient had severe moyamoya disease with an ipsilateral perfusion deficit and transient ischemic attacks. Given the need for revascularization, an STA-to-MCA bypass was performed. There was no suitable recipient M3 branch for direct anastomosis, and therefore an indirect bypass was performed by onlaying the STA onto the cortical surface and suturing the adventitia of the STA to the arachnoid of the underlying cortex. The dural leaflets were then inverted to potentiate further revascularization of the underlying cortex. The patient remained at their neurological baseline and demonstrated an enhanced perfusion of the ipsilateral MCA territory on follow-up evaluation. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
最常实施的低流量搭桥手术是颞浅动脉（STA）至大脑中动脉（MCA）搭桥术。若有合适的M2或M3皮质分支，将其与供体血管进行吻合。该患者患有严重的烟雾病，伴有同侧灌注不足和短暂性脑缺血发作。鉴于需要进行血管重建，实施了STA至MCA搭桥术。没有合适的受体M3分支用于直接吻合，因此通过将STA覆盖在皮质表面并将STA的外膜缝合至下方皮质的蛛网膜进行间接搭桥。然后将硬脑膜瓣翻转以增强下方皮质的进一步血管重建。患者保持神经功能基线状态，随访评估显示同侧MCA区域灌注增强。患者已签署手术及录像知情同意书。机构审查委员会批准被认为不必要。经亚利桑那州凤凰城巴罗神经学研究所许可使用。
