Background: Microanastomosis presents a challenge in neurosurgical procedures, requiring specialized skills. Regular practice outside the operating room is crucial. This study aims to provide a detailed description of the side-to-side anastomosis technique and analyze its advantages in preventing failures compared to other variations.
Material and methods: We examined the technique, characteristics, and outcomes of side-to-side bypass procedures for complex aneurysms in the ACA territory at our institution over the past decade. We compared our technique with those described in the literature by other groups.
Results: The FENI technique was employed in 15 patients, with 17 side-to-side anastomoses performed. The average anastomosis time was 27.5 minutes, with 100% patency in follow-up. Our technique demonstrated safety and effectiveness in treating intracranial aneurysms, yielding satisfactory short- and long-term functionality outcomes. We highlight the importance of maintaining a curvilinear arteriotomy shape, at least three times the diameter of the artery, and employing an interrupted suturing technique on the anterior wall.
Conclusion: This paper presents the first comprehensive description of the side-to-side anastomosis technique, supported with images and videos for training and replicability. Our technique enhances flow dynamics and reduces the risk of acute thrombus formation. Training in simulators and microsurgery practice centers outside the operating room is essential for acquiring and refining microsurgical skills.
Keywords: Cerebral revascularization; microsurgery; microvascular anastomosis; neurosurgical training; simulation.
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