深部脳血管バイパス術の基本と応用—STA-SCAバイパス術

Basic and Advanced Techniques of Anastomosis in Deep Surgical Fields:STA-SCA Anastomosis

I はじめに

　動脈硬化性椎骨脳底動脈閉塞で，その末梢の脳幹および小脳梗塞が限定的なとき，緊急—準緊急浅側頭動脈（superficial temporal artery：STA）-上小脳動脈（superior cerebellar artery：SCA）バイパス術が有効である^{1, 2）}．また，脳底動脈先端部巨大血栓化動脈瘤やコイル治療後再発などでSTA-SCAバイパス術を組み合わせたflow alteration therapyを選択すべきときがある．本稿では，subtemporal-transtentorial approachによるSTA-SCAバイパス術について，実践微小解剖学的見地から術中写真を用いて手術手技を詳述する．

　This article detailly describes the subtemporal-transtentorial STA-SCA bypass technique．Through temporal base drilling, copious cerebrospinal fluid evacuation before retraction, and sufficient retraction of the temporal lobe preserving the veins of the temporal base would be primodial to obtain an appropriate surgical field. Refrection of the tentrial free edge and identification of recipient SCA posterior to the entry point of the trochlear nerve into the cavernous sinus is a micro-anatomical key. Bilateral bayonet-type needle holders and forceps should be used not to shadow the surgical corridor with one's hands.