Aug 21, 2025
Revascularization techniques are widely employed in the treatment of cerebrovascular diseases and in the resection of complex skull base tumors involving major intracranial arteries. Among them, the superficial temporal artery–middle cerebral artery (STA–MCA) bypass is the most commonly performed, primarily indicated for moyamoya disease (MMD), internal carotid artery occlusive disease, and complex middle cerebral artery aneurysms (1–10 mm). Complete dissection of the STA and ensuring graft patency are essential prerequisites for successful STA–MCA bypass. At present, most neurosurgeons in China utilize sharp dissection or monopolar electrocautery for vessel harvesting. Bipolar electrocautery dissection, which originated in Japan, is widely practiced there and has been proven superior to monopolar dissection for STA harvesting, but its application remains limited in other countries and regions [1].
Common vessel dissection methods include sharp dissection, monopolar electrocautery, and bipolar electrocautery. Sharp dissection is the most traditional surgical technique but offers poor hemostatic efficacy and safety, while being time-consuming. Monopolar electrocautery relies on thermal energy to efficiently separate tissues and is considered safer than sharp dissection [2]. It is currently the most widely used vessel harvesting technique in China for cerebrovascular bypass. However, the significant thermal energy generated may damage vessels, causing vasospasm or occlusion. As a result, monopolar dissection is often performed at a distance from the target vessel, leaving excessive perivascular soft tissue. This not only reduces the effective length of the donor vessel but also increases the effort required for trimming. Residual soft tissue may also cause torsion of the donor artery, complicating placement and affecting the quality of the anastomosis. Furthermore, monopolar dissection results in more extensive scalp trauma and thermal injury, which can impair wound healing [3], and increase the risk of vasospasm or occlusion—ultimately reducing surgical success rates.
Bipolar electrocautery dissection offers a simpler and more efficient approach, enabling simultaneous dissection, coagulation, and separation without frequent instrument changes. Surgeons may operate with bipolar forceps in the right hand and a suction device in the left, achieving rapid and reliable hemostasis. During STA dissection, current is discharged only at the tips of the forceps, producing relatively less heat [4]. This minimizes wound injury, reduces soft-tissue adhesion, and yields longer, more pliable donor vessels, allowing surgeons to freely position the artery and select the optimal bypass site without compromising anastomosis. Moreover, while traditional monopolar cautery requires branch division followed by bipolar coagulation—often obscuring the surgical field—bipolar cautery can divide branches with minimal bleeding, thereby maintaining excellent visibility [1].
ShouLiang-med has independently developed bipolar forceps featuring mirror-polished technology, providing excellent conductivity, thermal efficiency, and anti-adhesion performance. The finely engineered tips are suitable for a wide range of neurosurgical procedures, allowing precise dissection and effective hemostasis of delicate vessels. A key innovation lies in the precise confinement of current to the forceps tips, significantly reducing collateral thermal injury. The anti-adhesion design, combined with the ability to coagulate while dissecting, enhances operative fluency and surgical field clarity, effectively reducing operative time.
References
[1] Li Y, Wang YJ, Cao Y, et al. Bipolar electrocautery vessel dissection: a novel technique for harvesting donor arteries in cerebral revascularization [J]. Chinese Journal of Modern Neurological Diseases, 2022, 22(05): 386–392.
[2] Charbel FT, Meglio G, Amin-Hanjani S. Superficial temporal artery–to–middle cerebral artery bypass [J]. Neurosurgery, 2005, 56(1 Suppl): 186–190.
[3] Chung Y, Lee SH, Choi SK. Fundamental basis of scalp layering techniques to protect against wound infection: a comparative study between conventional and in-to-out dissection of the superficial temporal artery [J]. World Neurosurg, 2017, 97: 304–311.
[4] Malis LI. Electrosurgery: technical note [J]. J Neurosurg, 1996, 85: 970–975.
Read More
IPv6 network supported
中文
