Short-Burst Bipolar Coagulation for Repairing Partially Damaged Brain Arteries Preserving Their Flow: Technical Note.

OBJECTIVE: Preservation of the integrity of perilesional and intralesional arteries, as well as of perforating vessels, is of utmost importance in microneurosurgery. The purpose of our study was to describe our adaptation of the short-burst bipolar coagulation technique, which was initially introduced by Professor Yasargil, for repairing partially damaged brain arteries.

METHODS: When a brain artery is partially and inadvertently damaged during microneurosurgical procedures, microscope magnification is further increased from the high magnification that is routinely used (10-15×) up to 14-17× in order to recognize clearly the injured zone of the vessel. Then the exact bleeding point is identified with a precise suction. Next, bipolar forceps with sharp tips (0.3 mm) are used to seal the wall of the injured artery, closing the borders of the hole between them. A delicate coagulation (20 Malis units, 3 watts) is performed for less than a second according to the so-called "open-close" technique. Short and small bursts of coagulation are used to progressively reduce the size of the defect by cauterization of the surrounding tissue. This gradually diminishes the bleeding up to restore the functional integrity of the vessel wall.

RESULTS: The senior author's modification of the Yasargil technique has been used for more than 30 years as a simple and fast method of microsurgical vascular repair of small tears.

CONCLUSIONS: The bipolar coagulation represents a safe, clean, fast, and even cheap method for repairing wall defects in fine arteries that are accidently damaged during a microsurgical operation.