{"title":"The \"One Coin Bypass\" Technique as a Minimally Invasive Navigation-Guided Superficial Temporal Artery to Middle Cerebral Artery Bypass.","authors":"Hiromasa Kobayashi, Takashi Morishita, Shintarou Yoshinaga, Dai Kawano, Toshiyuki Enomoto, Koichiro Takemoto, Tooru Inoue, Hiroshi Abe","doi":"10.1016/j.wneu.2025.124211","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Minimally invasive cerebral revascularization techniques are increasingly sought to reduce surgical trauma while preserving efficacy. The \"One Coin bypass\" 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.</p><p><strong>Methods: </strong>We retrospectively analyzed 29 patients who underwent single-vessel STA-MCA bypass for symptomatic internal carotid or middle cerebral artery stenosis or occlusion between 2017 and 2022. The One Coin bypass 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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>The One Coin bypass 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.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"124211"},"PeriodicalIF":1.9000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2025.124211","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: Minimally invasive cerebral revascularization techniques are increasingly sought to reduce surgical trauma while preserving efficacy. The "One Coin bypass" 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.
Methods: We retrospectively analyzed 29 patients who underwent single-vessel STA-MCA bypass for symptomatic internal carotid or middle cerebral artery stenosis or occlusion between 2017 and 2022. The One Coin bypass 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).
Results: 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.
Conclusion: The One Coin bypass 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.
背景和目的：微创脑血运重建术越来越多地寻求减少手术创伤，同时保持疗效。“一枚硬币旁路”是一种导航引导颞浅动脉到大脑中动脉（STA-MCA）的旁路手术，通过硬币大小的颅骨切除术和3.0厘米的皮肤切口进行。本研究旨在评价其临床可行性及手术效果。方法：回顾性分析2017年至2022年间29例因症状性颈内动脉或大脑中动脉狭窄或闭塞接受单血管STA-MCA搭桥治疗的患者。一枚硬币旁路于2021年1月推出；早期病例作为历史对照组。比较One Coin组（n=10）和常规旁路组（n=19）的手术参数和临床结果。结果：One Coin组皮肤切口明显缩短（3.0 cm vs. 8.0±2.3 cm, p < 0.05），开颅直径明显减小（17 mm vs. 45±5.7 mm, p < 0.05），总手术时间明显缩短（136±13.1 min vs. 219±31.1 min, p < 0.05）。吻合次数比较（p = 0.837）。One Coin组无重大并发症发生，而常规组有1例梗死。所有的旁路仍然是专利。结论：One Coin旁路被证明是一种安全有效的微创替代传统STA-MCA旁路，在不影响旁路质量的情况下减少手术暴露。对老年人或高危患者尤其有利。
期刊介绍：
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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