Extracranial-intracranial bypass surgery at high magnification using a new high-resolution operating microscope: technical note

Abstract 

Background

We report a precise technique for EC-IC bypass surgery using a stereoscopic high-resolution microscope at magnifications of 40× and 50×.

Methods

A stereoscopic operating microscope (Mitaka MM50 Surgical Microscope; Mitaka Kohoki Co, Tokyo, Japan) was used in STA-MCA anastomosis. This microscope has 2 optical systems, a standard zooming system, a newly developed high-magnification system, and 4 fixed working distances of 200, 250, 300 and 350 mm, with highest magnifications of 50.4× at 200 mm and 40.3× at 250 mm. High resolution is achieved by a new lens design in the optical system, which makes the image of the object very clear at high magnification. The magnification can be changed depending on the circumstances in a given procedure. The STA-MCA anastomoses were performed using this microscope.

Results

Very small vessels were observable, and arterial anastomosis could be performed precisely at high magnification. All anastomoses were patent on postoperative angiograms.

Conclusions

Use of the new microscope allows visualization and manipulation of small vessels at high magnification and high resolution and may be very useful in EC-IC bypass surgery.

Abbreviations: EC, extracranial, IC, intracranial, MCA, middle cerebral artery, STA, superficial temporal artery

Keywords: Extracranial-intracranial bypass, Superficial temporal artery–to–middle cerebral artery anastomosis, Operating microscope, Microvascular anastomosis