Abstract：
The lateral supraorbital (LSO) approach is a minimally invasive craniotomy widely used in the surgical treatment of intracranial aneurysms (IAs). A protective bypass is considered a safety measure in high-risk and complex clipping procedures to maintain distal cerebral flow. However, the protective bypass has so far only been applied through a pterional or larger craniotomy. We aimed to describe the characteristics of the superficial temporal artery to middle cerebral artery (STA-MCA) bypass through the LSO craniotomy to treat complex IAs.
We retrospectively identified six patients with complex IAs who underwent clipping and a protective STA-MCA bypass through the LSO approach between January 2016 and December 2020. The STA donor artery was harvested through the same curvilinear skin incision with a small extension, and it was anastomosed to the opercular segment of the MCA. Subsequently, aneurysm clipping followed standardized steps.
Anastomosis was successful in all patients. Despite requiring temporary occlusion of the parent artery, all aneurysms were successfully clipped without any neurological deterioration.
A protective STA-MCA bypass is feasible through the LSO approach with certain technical modifications. This technique helps protect distal cerebral flow for safe clip placement in the treatment of complex IAs with the associated benefits of a less invasive craniotomy.
We retrospectively identified six patients with complex IAs who underwent clipping and a protective STA-MCA bypass through the LSO approach between January 2016 and December 2020. The STA donor artery was harvested through the same curvilinear skin incision with a small extension, and it was anastomosed to the opercular segment of the MCA. Subsequently, aneurysm clipping followed standardized steps.
Anastomosis was successful in all patients. Despite requiring temporary occlusion of the parent artery, all aneurysms were successfully clipped without any neurological deterioration.
A protective STA-MCA bypass is feasible through the LSO approach with certain technical modifications. This technique helps protect distal cerebral flow for safe clip placement in the treatment of complex IAs with the associated benefits of a less invasive craniotomy.
摘要：
目的：眶上外侧（LSO）入路是一种微创开颅手术，广泛用于颅内动脉瘤（IAs）的手术治疗。在高风险和复杂的夹闭手术中，保护性旁路被认为是维持远端脑血流的安全措施。然而,到目前为止，保护性旁路仅通过翼状或更大的开颅术应用。我们旨在通过LSO开颅术描述颞浅动脉到大脑中动脉（STA-MCA）旁路的特征，以治疗复杂的IA。
方法：我们回顾性地确定了6例复杂IAs患者，他们在2016年1月至2020年12月期间通过LSO方法进行了夹闭和保护性STA-MCA旁路手术。STA供体动脉通过相同的曲线皮肤切口采集，并有一个小的延伸，它与MCA的手术段吻合。随后，动脉瘤夹闭遵循标准化步骤。
结果：所有患者吻合均成功。尽管需要暂时封堵父动脉,所有动脉瘤均成功夹闭,无任何神经系统恶化.
结论：通过LSO方法进行某些技术修改，保护性STA-MCA旁路是可行的。该技术有助于在复杂的IAs治疗中保护远端脑血流，以安全地放置夹子，并具有侵入性较小的开颅手术的相关益处。
方法：我们回顾性地确定了6例复杂IAs患者，他们在2016年1月至2020年12月期间通过LSO方法进行了夹闭和保护性STA-MCA旁路手术。STA供体动脉通过相同的曲线皮肤切口采集，并有一个小的延伸，它与MCA的手术段吻合。随后，动脉瘤夹闭遵循标准化步骤。
结果：所有患者吻合均成功。尽管需要暂时封堵父动脉,所有动脉瘤均成功夹闭,无任何神经系统恶化.
结论：通过LSO方法进行某些技术修改，保护性STA-MCA旁路是可行的。该技术有助于在复杂的IAs治疗中保护远端脑血流，以安全地放置夹子，并具有侵入性较小的开颅手术的相关益处。
