A simple surgical technique of direct anastomosis for treatment of moyamoya disease: technical note.

Surg Neurol

Department of Neurosurgery, Touho Neurosurgical Clinic, Osaka 563-0026, Japan.

Published: October 2004

AI Article Synopsis

  • An arteriotomy on the middle cerebral artery can cause the artery to collapse, complicating surgeries for moyamoya disease.
  • A 3-0 polypropylene suture was used to keep the artery's lumen open during microsurgery, allowing for easier access without damaging the artery's wall.
  • This technique simplifies anastomosis even in very small arteries (as small as 0.5 mm), making procedures more efficient.

Article Abstract

Background: An arteriotomy on a branch of the middle cerebral artery (MCA) is required in the procedure of the direct anastomosis for the treatment of moyamoya disease, and the artery comes to be collapsed after blood is washed out. The phenomenon makes the microsurgical procedure difficult during direct anastomosis.

Methods: A piece of 3-0 blue monofilament polypropylene suture (PROLENE*, ETHICON Inc., a Johnson & Johnson Company, Somerville, New Jersey) was inserted into the lumen of the recipient artery though the ostium after termination of arteriotomy. The diameter of 3-0 PROLENE* was between 0.20 and 0.249 mm. PROLENE*, a length that was more than the length of the arteriotomy and was less than the distance between the 2 occlusion clamps placed on the recipient artery. At this time, the lumen was reopened and the wall of the recipient artery was easily passed by a microneedle with 11-0 monofilament without injury to the posterior wall of the recipient artery by the microneedle. Confirmation as to whether the microneedle snagged and injured the posterior wall of the recipient artery or not was unnecessary with this method.

Results: Anastomosis was easily performed using this technique for the treatment of moyamoya disease.

Conclusions: Clinical application of the present technique makes the anastomotic procedure easy, even when the diameter of the recipient artery is as small as 0.5 mm.

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Source
http://dx.doi.org/10.1016/j.surneu.2003.11.007DOI Listing

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