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Background: Superficial temporal artery (STA)-middle cerebral artery (MCA) side-to-side microvascular anastomosis can achieve the same clinical effects as traditional STA-MCA end-to-side anastomosis in extracranial-intracranial revascularization surgery, furthermore, STA-MCA side-to-side anastomosis has the lower risk of postoperative cerebral hyperperfusion syndrome (CHS) and the potential to recruit all scalp arteries as the donor sources via self-regulation. Therefore, STA-MCA side-to-side microvascular anastomosis seems to be a revascularization strategy superior to traditional STA-MCA end-to-side anastomosis. In this study, we presented seven cases in which a STA-MCA side-to-side microvascular anastomosis was performed with a 4–5 mm long arteriotomy using the in-situ intraluminal suturing technique. Methods: Superficial temporal artery (STA)-middle cerebral artery (MCA) side-to-side anastomosis was performed in seven patients using the in-situ intraluminal suturing technique. Results: The diameters of the recipient MCA and the donor STA were approximately 0.94 mm (range 0.8–1.4 mm) and 1.65 mm (range 1.4–2.0 mm), respectively, and the length of the arteriotomy was approximately 4.71 mm (range 4–5 mm). The MCA was temporarily occluded in approximately 25.00 min (range 20–29 min). 100% patency rates of the STA-MCA microvascular anastomosis were achieved in all patients. No obvious CHS was recorded. Intraoperative Indocyanine green videoangiography (ICG-VA) and postoperative digital subtraction angiography (DSA) demonstrated three different blood flow distribution patterns after the STA-MCA side-to-side anastomosis, the donor MCA received not only antegrade blood flow from the proximal preanastomotic STA but also retrograde blood flow from the distal postanastomotic STA in one case; the donor MCA received all the antegrade blood from the proximal STA without retrograde blood flow from the distal STA in two case; whereas, the recipient MCA territories received only partial antegrade blood flow from the proximal preanastomotic STA. Conclusions: STA-MCA side-to-side microvascular anastomosis with a 4–5 mm long arteriotomy using the in situ intraluminal suturing technique is a safe and effective revascularization surgery, and the anastomosis can serve as a shunt for blood flow self-regulation. [ABSTRACT FROM AUTHOR]

Background The surgical 3D exoscopes have recently been introduced as an alternative to the surgical microscopes in microneurosurgery. Since the exoscope availability is still limited, it is relevant to know whether even a short-term exoscope training develops the skills needed for performing exoscope-assisted surgeries. Methods Ten participants (six consultants, four residents) performed two laboratory bypass test tasks with a 3D exoscope (Aesculap Aeos®). Six training sessions (6 h) were performed in between (interval of 2–5 weeks) on artifcial models. The participants were divided into two groups: test group (n=6) trained with the exoscope and control group (n=4) with a surgical microscope. The test task was an artifcial end-to-side microsurgical anastomosis model, using 12 interrupted 9–0 sutures and recorded on video. We compared the individual as well as group performance among the test subjects based on suturing time, anastomosis quality, and manual dexterity. Results Altogether, 20 bypass tasks were performed (baseline n=10, follow-up n=10). The median duration decreased by 28 min and 44% in the exoscope training group. The decrease was steeper (29 min, 45%) among the participants with less than 6 years of microneurosurgery experience compared to the more experienced participants (13 min, 24%). After training, the participants with at least 1-year experience of using the exoscope did not improve their task duration. The training with the exoscope led to a greater time reduction than the training with the microscope (44% vs 17%). Conclusions Even short-term training with the exoscope led to marked improvements in exoscope-assisted bypass suturing among novice microneurosurgeons. For the more experienced participants, a plateau in the initial learning curve was reached quickly. A much longer-term efort might be needed to witness further improvement in this user group. [ABSTRACT FROM AUTHOR]

Background: Perfused placentas provide an excellent and accessible model for microvascular dissection, microsuturing and microanastomosis training — particularly in the early microsurgical learning curve. This way, a significant amount of live animals can be spared. Method: We present the Zurich Microsurgery Lab protocol, detailing steps for obtaining, selecting, cleaning, flushing, cannulating, and preserving human placentas — as well as microsurgical training examples — in a tried-and-true, safe, cost-effective, and high-yield fashion. Conclusion: Our technique enables highly realistic microsurgical training (microdissection, microvascular repair, microanastomosis) based on readily available materials. Proper handling, preparation, and preservation of the perfused placenta models is key. [ABSTRACT FROM AUTHOR]

Background: A variety of revascularization techniques have been reported for the management of moyamoya disease to prevent risks of stroke. STA (superficial temporal artery)–MCA (middle cerebral artery) microanastomosis, single or double bypass, with temporal muscle or galeal onlay graft has been the standard operative procedure. Method: Our rationale of revascularization surgery has been a combination of STA-MCA double bypass using the frontal and the parietal branches of STA and transfer of a highly vascularized thick galeal flap with maintained STA vasculature. Conclusion: This STA-enhanced vascularized galeal flap graft is extremely effective for revascularization of moyamoya disease. [ABSTRACT FROM AUTHOR]

Yasagil temporary clips have been widely used in extracranial-intracranial (EC-IC) arterial bypass surgery. However, the extremely delicate vessels involved often require the application of finer clips. We report on the use of the Kopitnik arteriovenous malformation (AVM) microclip system for superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Kopitnik AVM microclips are new mechanical devices that are used during AVM surgery. They exert a pre-defined closing force of 50–70 g, and also feature a special, pyramid-shaped structure stamped on inner surfaces of the blades. These characteristics avoid vascular intimal injury and provide a secure grip. We prospectively studied their use in 15 patients requiring STA-MCA anastomosis. Clinical results were excellent and there were no new ischemic events during 6-months’ follow-up. Kopitnik AVM microclips have several advantages; they have small and variously sized clip blades (2, 3, 4 and 5 mm), and the small clip head allows the operator an excellent view of the pathology and clip status. The Kopitnik AVM microclip appears to be clinically effective and safe for EC-IC bypass surgery, especially when smaller vessels are involved. [ABSTRACT FROM AUTHOR]

In the present study 48 thermic vascular anastomoses performed in Sprague Dawley Wistar rats were subjected to analysis by scanning electron microscopy. Depending on the period of postoperative survival (up to 18 months) normal smooth endothelium, dissected cuffs and aneurysms were seen. Endothelial damage through heat application following bipolar coagulation was only slight. In one 18 months old anastomosis an aneurysm with a delicate network of endothelialized filaments was seen leaving a free passage for the blood flow centrally. A comparison of the literature describing the healing processes of intima following various traumas is made. [ABSTRACT FROM AUTHOR]