The "One Coin Bypass" Technique as a Minimally Invasive Navigation-Guided Superficial Temporal Artery to Middle Cerebral Artery Bypass.

Abstract

Minimally invasive cerebral revascularization techniques are increasingly sought to reduce surgical trauma while preserving efficacy. The "One Coin bypass" (OCB) is a navigation-guided superficial temporal artery to middle cerebral artery (STA-MCA) bypass performed through a coin-sized craniectomy and 3.0 cm skin incision. This study aimed to evaluate its clinical feasibility and surgical benefits. We retrospectively analyzed 29 patients who underwent single-vessel STA-MCA bypass for symptomatic internal carotid or MCA stenosis or occlusion between 2017 and 2022. The OCB was introduced in January 2021; earlier cases served as a historical control group. Surgical parameters and clinical outcomes were compared between the One Coin group (n = 10) and the conventional bypass group (n = 19). The One Coin group had significantly shorter skin incisions (3.0 cm vs. 8.0 ± 2.3 cm, P < 0.05), smaller craniectomy diameter (17 mm vs. 45 ± 5.7 mm, P < 0.05), and reduced total operative time (136 ± 13.1 min vs. 219 ± 31.1 min, P < 0.05). Anastomosis times were comparable (P = 0.837). No major complications occurred in the One Coin group, while one infarction was noted in the conventional group. All bypasses remained patent. The OCB was shown to be a safe and effective minimally invasive alternative to conventional STA-MCA bypass, offering reduced surgical exposure without compromising bypass quality. It may be especially advantageous in elderly or high-risk patients.