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The preparation of anastomosis site at the insular segment of middle cerebral artery

BACKGROUND: An anastomosis at the insular segment of the middle cerebral artery (M2) is often required in cerebral reconstruction with high- or low-flow bypass. It is necessary to create a shallow, wide, fixed, and bloodless anastomosis field to achieve a safe and quick anastomosis for low surgical...

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Autores principales: Katsuno, Makoto, Tanikawa, Rokuya, Izumi, Naoto, Hashimoto, Masaaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093771/
https://www.ncbi.nlm.nih.gov/pubmed/25024885
http://dx.doi.org/10.4103/2152-7806.133992
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author Katsuno, Makoto
Tanikawa, Rokuya
Izumi, Naoto
Hashimoto, Masaaki
author_facet Katsuno, Makoto
Tanikawa, Rokuya
Izumi, Naoto
Hashimoto, Masaaki
author_sort Katsuno, Makoto
collection PubMed
description BACKGROUND: An anastomosis at the insular segment of the middle cerebral artery (M2) is often required in cerebral reconstruction with high- or low-flow bypass. It is necessary to create a shallow, wide, fixed, and bloodless anastomosis field to achieve a safe and quick anastomosis for low surgical morbidity. We describe a method to perform a safe and quick anastomosis. METHODS: From 2009 to 2013, the technique was used in 20 procedures to create an extracranial M2 high-flow bypass. The Sylvian fissure was dissected wide open to expose the M2. A silicon sheet was laid under M2 and the absorbable gelatin-compressed sponges were inserted between M2 and the insula cortex to lift up the M2 and fix it. The rolling surgical sheets were placed at each edge of the dissected Sylvian fissure, instead of brain spatulas. Finally, a small suction tube was placed at the Sylvian fissure and cerebrospinal fluid was continuously sucked. The postoperative patency of the bypass was evaluated by three-dimensional computed tomographic angiography (3D-CTA) in the acute and chronic stages. RESULTS: In all cases, the operation field acquired for the anastomosis was adequate. The average time required for the procedure was 19 min 27 s. Good patency of all high-flow grafts was confirmed by postoperative three-dimensional computed tomography angiography (3D-CTA). CONCLUSION: In our series, there were no technical complications related to the anastomosis at M2 performed according to our method.
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spelling pubmed-40937712014-07-14 The preparation of anastomosis site at the insular segment of middle cerebral artery Katsuno, Makoto Tanikawa, Rokuya Izumi, Naoto Hashimoto, Masaaki Surg Neurol Int Technical Note BACKGROUND: An anastomosis at the insular segment of the middle cerebral artery (M2) is often required in cerebral reconstruction with high- or low-flow bypass. It is necessary to create a shallow, wide, fixed, and bloodless anastomosis field to achieve a safe and quick anastomosis for low surgical morbidity. We describe a method to perform a safe and quick anastomosis. METHODS: From 2009 to 2013, the technique was used in 20 procedures to create an extracranial M2 high-flow bypass. The Sylvian fissure was dissected wide open to expose the M2. A silicon sheet was laid under M2 and the absorbable gelatin-compressed sponges were inserted between M2 and the insula cortex to lift up the M2 and fix it. The rolling surgical sheets were placed at each edge of the dissected Sylvian fissure, instead of brain spatulas. Finally, a small suction tube was placed at the Sylvian fissure and cerebrospinal fluid was continuously sucked. The postoperative patency of the bypass was evaluated by three-dimensional computed tomographic angiography (3D-CTA) in the acute and chronic stages. RESULTS: In all cases, the operation field acquired for the anastomosis was adequate. The average time required for the procedure was 19 min 27 s. Good patency of all high-flow grafts was confirmed by postoperative three-dimensional computed tomography angiography (3D-CTA). CONCLUSION: In our series, there were no technical complications related to the anastomosis at M2 performed according to our method. Medknow Publications & Media Pvt Ltd 2014-06-05 /pmc/articles/PMC4093771/ /pubmed/25024885 http://dx.doi.org/10.4103/2152-7806.133992 Text en Copyright: © 2014 Katsuno M. http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Technical Note
Katsuno, Makoto
Tanikawa, Rokuya
Izumi, Naoto
Hashimoto, Masaaki
The preparation of anastomosis site at the insular segment of middle cerebral artery
title The preparation of anastomosis site at the insular segment of middle cerebral artery
title_full The preparation of anastomosis site at the insular segment of middle cerebral artery
title_fullStr The preparation of anastomosis site at the insular segment of middle cerebral artery
title_full_unstemmed The preparation of anastomosis site at the insular segment of middle cerebral artery
title_short The preparation of anastomosis site at the insular segment of middle cerebral artery
title_sort preparation of anastomosis site at the insular segment of middle cerebral artery
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093771/
https://www.ncbi.nlm.nih.gov/pubmed/25024885
http://dx.doi.org/10.4103/2152-7806.133992
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