Abstract
Background Superficial temporal artery to middle cerebral artery (STA-MCA) bypass is a treatment
option for hemodynamic insufficiency in the anterior cerebral circulation. Complications
associated with extracranial-intracranial bypass surgeries are ischemic strokes caused
by bypass failure, wound-healing disorders, and further issues from cerebrospinal
fluid (CSF) leakage. CSF leakage can provide pathways for infection. It is well known
in general neurosurgery that watertight closure of the dura mater is necessary to
prevent such complications.
Objective To provide a technical description of TachoSil dural reconstruction in standard STA-MCA
bypasses and their follow-up analyses.
Methods In this technical report with observational follow-up, the dura mater was closed
partially by adaptive sutures, and the perforation site of the donor vessel was sealed
with TachoSil. TachoSil is a collagen sponge covered with clotting factors that provides
hemostatic and sealing effects.
Results Our study included eight cases of standard STA-MCA bypasses that had been operated
between July 2015 and September 2016. Follow-up examinations were completed for all
patients at 1 month and 6 months after surgery. Duplex and Doppler ultrasound demonstrated
regular bypass patency in all patients without increased flow velocity at the perforation
sites, which is a possible sign of stenosis. No wound-healing disorders or CSF leakage
occurred. No cerebrovascular stroke events were observed.
Conclusion Duraplasty with TachoSil enables the elastic reconstruction of the dura perforation
gap in standard extracranial-intracranial bypass surgeries.
Keywords
cerebral ischemia - dural closure - extracranial-intracranial bypass - STA-MCA bypass
- TachoSil
