手術手技の流派を知るⅡ：スタンダード手技—STA-MCAバイパス術の基本手技

Fundamental Surgical Techniques of Superficial Temporal Artery:Middle Cerebral Artery （STA-MCA） Bypass

Point

・硬膜はしっかりと止血し，硬膜外からのたれ込みもないようにセッティングを行うことが重要である．

・もやもや病では内腔を強拡大で確認しながら，縫い込みがないように吻合を進める．

・吻合の手の動きをoff the job trainingでマスターしておく．

　Superficial temporal artery-middle cerebral artery（STA-MCA）bypass surgery is necessary for vascular reconstruction in patients with hemodynamic ischemia, including moyamoya disease and complex aneurysms. This report introduces the fundamental techniques of STA-MCA bypass surgery practiced in my institute. Preoperative and perioperative management is important to minimize complications. During the procedure, the operator should keep a bloodless surgical field to facilitate the bypass. The vascular lumen and intima must be carefully observed during anastomosis, especially in moyamoya cases. In addition, this study emphasizes the importance of off-the-job training using animal or synthetic arteries because this technique includes special movements compared with that of other microsurgical procedures.