title: Microsurgical neurovascular anastomosis: the example of superficial temporal artery to middle cerebral artery bypass. Technical principles.
abstract: The superficial temporal artery to the middle cerebral artery (STA-MCA) bypass is a good example of cerebrovascular anastomosis. In this article, we describe the different stages of the procedure: patient installation, superficial temporal artery harvesting, recipient artery exposure, microsurgical anastomosis, and closure of the craniotomy. When meticulously performed, with the observance of important details at each stage, this technique offers a high rate of technical success (patency>90%) with a very low morbi-mortality (respectively 3% and 1%). Some anesthetic parameters have to be considered to insure perioperative technical and clinical success. STA-MCA bypass is a very useful technique for the management of complex or giant aneurysms where surgical treatment sometimes requires the sacrifice and revascularization of a main arterial trunk. It is also a valuable option for the treatment of chronic and symptomatic hemispheric hypoperfusion (Moyamoya disease, carotid or middle cerebral artery occlusion).
authors.affiliation: Clinique neurochirurgicale, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille cedex, France; Université Lille Nord de France, 59000 Lille, France. Electronic address: laurent.thines@wanadoo.fr.
authors.forename: L
authors.initials: L
authors.lastname: Thines
authors.affiliation: Clinique du Tonkin, 69626 Villeurbanne cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Durand
authors.affiliation: Clinique universitaire de neurochirurgie, hôpital Pellegrin Tripode, centre hospitalier universitaire, 33076 Bordeaux cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Penchet
authors.affiliation: Service de neurochirurgie, hôpital Charles-Nicolle, centre hospitalier régional universitaire, 76031 Rouen cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Proust
authors.affiliation: Pôle d'anesthésie-réanimation, centre hospitalier régional universitaire, 59037 Lille cedex, France.
authors.forename: H
authors.initials: H
authors.lastname: Lenci
authors.affiliation: Pôle d'anesthésie-réanimation, centre hospitalier régional universitaire, 59037 Lille cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Debailleul
authors.affiliation: Clinique neurochirurgicale, pôle des neurosciences et de l'appareil locomoteur, hôpital Roger-Salengro, centre hospitalier régional universitaire, avenue Emile-Laine, 59037 Lille cedex, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lejeune
authors.affiliation: Service de neurochirurgie D, hôpital Wertheimer, centre hospitalier universitaire, 69394 Lyon cedex 03, France.
authors.forename: I
authors.initials: I
authors.lastname: Pelissou-Guyotat
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D002548:Cerebral Revascularization / Q000379:methods; D006801:Humans; D008866:Microsurgery / Q000379:methods*; D020768:Middle Cerebral Artery / Q000601:surgery*; D009072:Moyamoya Disease / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D013699:Temporal Arteries / Q000601:surgery
keywords: Anastomose temporo-sylvienne; Anévrisme géant; Cerebral ischemia; Extracranial-intracranial bypass; Giant aneurysms; Ischémie cérébrale; Moyamoya; Moyamoya disease; Pontage extracrânien-intracrânien; Superficial temporal artery to middle cerebral artery bypass