• Khaled Krisht, Jose Manuel Orenday-Barraza, Hassan Saad, and Ali F Krisht.
• Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas, USA. Electronic address: khaledkrisht@yahoo.com.
• World Neurosurg. 2021 Feb 1; 146: 113-117.

ObjectiveDespite failure of the EC/IC Bypass Study Group to demonstrate effectiveness in minimizing future stroke events, superior temporal artery-medial cerebral artery (STA-MCA) bypass remains an essential treatment for complex giant intracranial aneurysms, tumors, moyamoya disease with ischemia, and atherosclerotic steno-occlusive disease with hemodynamic cerebrovascular insufficiency. The objective of this report is to describe a novel suturing technique for STA-MCA bypass that helps reduce donor-recipient anastomosis time, allowing for a well-organized systematic workflow.MethodsStep 1 involves passing the needle of a 9-0 polypropylene suture from out-to-in on the donor vessel followed by in-to-out on the recipient vessel. Step 2: Before cutting and tying a knot as per the established method of suturing, repeat step 1 and leave the needle "parked", creating a loop that is then cut at its proximal end. Step 3: Tie knots using the jeweler's forceps. Repeat previous steps until there are enough throws to seal the bypass adequately.ResultsThe STA-MCA bypass serves as a principal method for flow augmentation. The technique described here allows for more efficient and organized microsurgical movements reducing vessel tissue manipulation and clamp time.ConclusionsWe describe a novel technique for interrupted STA-MCA bypass suturing that adds efficiency, safety, organization, and operative ease compared with the conventional method of interrupted vessel suturing.Published by Elsevier Inc.

17 keywords...

hide…