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How I do it: superficial temporal artery to middle cerebral artery bypass for moyamoya disease

  • How I Do it - Vascular Neurosurgery - Ischemia
  • Published:
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Abstract

Background

Moyamoya disease (MMD) is a chronic progressive disease leading to recurrent stroke due to occlusion of the terminal internal carotid arteries. Surgical revascularization for symptomatic MMD is an effective treatment for preventing further stroke. However, direct revascularization of advanced MMD remains challenging due to small caliber of the recipient vessel and perforators.

Methods

We introduce our technique of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass with figures and video to illustrate the procedure.

Conclusion

Surgical nuances of STA to MCA anastomosis will help cerebrovascular neurosurgeons to master low-flow bypass for MMD.

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Author information

Author notes

  1. Yujun Liao and Feng Xu contributed equally to this work

Authors and Affiliations

  1. Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Road, Shanghai, China

    Yujun Liao, Feng Xu & Bin Xu

  2. National Center for Neurological Disorders, Shanghai, China

    Yujun Liao, Feng Xu & Bin Xu

  3. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China

    Yujun Liao, Feng Xu & Bin Xu

  4. Neurosurgical Institute of Fudan University, Shanghai, China

    Yujun Liao, Feng Xu & Bin Xu

  5. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

    Yujun Liao, Feng Xu & Bin Xu

Authors
  1. Yujun Liao
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  2. Feng Xu
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  3. Bin Xu
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Corresponding author

Correspondence to Bin Xu.

Ethics declarations

Ethics approval and consent to participate

Approval was obtained from the ethics committee of Huashan Hospital, Fudan University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Informed consent was obtained from individual participant included in the study.

Conflict of interest

The authors declare no competing interests.

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Key points

1. Perioperative blood pressure monitoring is important.

2. The middle meningeal artery should be preserved during craniotomy.

3. Dissecting the parietal branch of the STA from the scalp flap is a safe and rapid way.

4. Periadventitial tissues are dissected from the STA using sharp dissection.

5. Two slightly curved miniclips are used to temporarily occlude the recipient artery without sacrificing any perforators.

6. The bypass is initiated at the toe stitch so as to appropriately match donor with recipient.

7. Square knot is carefully made without any kinking of the suture.

8. Interrupted sutures are performed on each side of the arteriotomy.

9. Grasping the intima should be avoided during traction and countertraction on the vessels being sutured.

10. Bypass patency is confirmed with intraoperative ICG angiography.

This article is part of the Topical Collection on Vascular Neurosurgery—Ischemia

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 74839 KB) Video 1: STA-MCA bypass for MMD

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Liao, Y., Xu, F. & Xu, B. How I do it: superficial temporal artery to middle cerebral artery bypass for moyamoya disease. Acta Neurochir 164, 1855–1859 (2022). https://doi.org/10.1007/s00701-022-05255-1

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  • DOI: https://doi.org/10.1007/s00701-022-05255-1

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