This is another video describing the STA-MCA bypass for Moya-Moya disease. This is a 54 year old female who presented with progressive right-sided ischemic episodes related to her known Moya-Moya disease. Spec studies confirmed evidence of hypoperfusion in the right hemisphere. These are some of the basic CT angiogram findings related to Moya-Moya disease. Patient subsequently underwent a right small frontotemporal Craniotomy. The STA graft was also prepared ahead of the time. A cortical vessel was exposed and prepared. An Arteriotomy was completed as described in our previous videos. Small plastic tubing may be placed within the lumen of the recipient vessel to prevent the risk of suturing in the back wall of the anastomosis. The Arteriotomy is extended to at least five or six millimeters. 9-0 suture is used to approximate the heal of the anastomosis, after the end of the STA vessel is fish mouthed. ample amount of hyper irrigation is used. Following completion of the heel. The toe of the STA is used to complete the other end of anastomosis. Again, these are 9-0 sutures versus 8-0 sutures that close the two lines of the anastomosis on both sides. The knots are properly laid down. Next. This line of Arteriotomy is approximated with the age of the STA Intermittent Suturing technique is used. The other Arteriotomy line is also sutured in the plastic tubing will prevent any potential for suturing in the back wall. The tubing is removed before the final sutures are placed. Following completion of the anastomosis, all the temporary clips are removed an ICG angiogram is performed to confirm patency within the graft, which is evident here. All the vessels are patent. Dural closure and placement of the bone flap should consider ample amount of space around the STA to prevent any interference with the flow of the graft. Postoperative angiogram, in this case demonstrates a very healthy STA feeding, a large portion of the distal MCA territory. Postoperative CT also excluded any evidence of ischemia and this patient made an excellent recovery. Thank you.
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