STA to MCA Bypass. 3D HD. Brain bypass surgery.
This video will demonstrate a direct STA to MCA bypass in a patient with M1 stenosis. This is a 66 year old female who presented with a basal ganglia stroke. CT perfusion showed a left MCA perfusion deficit on the mean transit time. The patient on angiography was found to have critical M1 stenosis adjacent to the lenticulostriates. We can see a large early takeoff of the anterior temporal artery branch. Here we can see the postop bypass graft and resolution (after surgery) of the left MCA perfusion deficit. A comparison of the post bypass and pre-bypass CT perfusion The frontal branch (of the STA) was used and sewn with continuous 10-0 suture Here's the STA as it is being dissected away from the temporalis muscle.
STA seen directly over the fronto temporal region of the brain An overview of the bypass. The patient went home on postoperative day number 7 on Aspirin. Here is the video.
The STA is fish-mouthed to allow for a longer suture line on either side of the MCA. The arteriotomy is made with right-angle arteriotomy scissors. Again as we saw in the still photo, the blue background has 1 by 1 millimeter boxes.
Now the heal stitch is created. And the needle is left there until later. And then the toe is sewn (opposite). To bring the STA together with the M4 (MCA) branch on the other end. Now running continuous suture will be used.
10-0 Nylon. Used on either side starting with the left side of the screen. Starting with the STA and then passing the suture through the MCA second. Through the outer wall. And then continuous sewing with 10-0 Nylon. Diameter is 0.02 mm of the suture. And then at the end the suture is tightened. The suture is not tightened until the end because if it is tightened as one goes along it could loosen up, so we make sure to tighten at the end, right before tying the sutures.
And now the other side again, using a running suture. This time passing through the MCA vessel wall first and then the STA. Continuous running suture and then tying the ends. Three knots. Making sure the knows lay down flat (squarely).
The clips are removed from the M4 branch as well as the STA. Fibrillar is used used on the vessel for hemostasis and to control any minor ooze. The IC green is performed showing flow in the bypass graft and then the postoperative CTA is seen.
This video will demonstrate a direct STA to MCA bypass in a patient with M1 stenosis. This is a 66 year old female who presented with a basal ganglia stroke. CT perfusion showed a left…By: San Francisco, Vascular Neurosurgery, Adib Abla MD
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