Moyamoya Direct Bypass Surgery

Technique for Direct Bypass Surgery:

 

A1

  • Map out STA anterior to zygomatic arch for 8-9cm, using Doppler.

 

B1

  • Dissect STA and vascular cuff under microscope.

 

C1

  • Incise temporalis muscle in H-shaped fashion.
  • Create 6x6cm craniotomy over frontotemporal region.

 

D1

  • Open dura wide over Sylvian fissure, under high magnification, identify M4 recipient artery.

 

 

E1

  • Cut distal STA at 45 degrees, place temporary clips on recipient artery.
  • Make an elliptical arteriotomy over M4 branch.
  • Perform end-to-side anastomosis using 10 to 0 interrupted suture under high magnification.
  • Remove temporary clips from recipient and proximal STA once bypass completed.

 

F1

  • Place STA and vascularized cuff in close apposition to cortical surface to facilitate delayed collateralization

 

Reference:

Liu, Jonathan J., and Gary K. Steinberg. “Direct Versus Indirect Bypass For Moyamoya Disease”. Neurosurgery Clinics of North America 28.3 (2017): 361-374.

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