• Ryohei Miyazaki, Hidetoshi Murata, Mitsuru Sato, Ryu Ueno, Naoki Ikegaya, Shutaro Matsumoto, Hiroyuki Abe, Kagemichi Nagao, Nobuyuki Shimizu, Kensuke Tateishi, Jun Suenaga, and Tetsuya Yamamoto.
• Department of Neurosurgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
• World Neurosurg. 2020 Sep 1; 141: 196-202.

BackgroundCerebral bypass surgery, such as the superficial temporal artery-middle cerebral artery bypass, is one of the essential procedures for cerebral revascularization. However, very narrow or thin blood vessels will increase the risk of anastomotic problems, such as occurs in Moyamoya disease. For such vessels, we have devised a "lifting method" in the recipient arteriotomy. In the present study, we have introduced this novel optional technique and evaluated its effects.MethodsThe lifting method is a procedure of lifting the incision edge of a linear incision on the recipient vessel to widen the ostium. We attempted the lifting method in 23 consecutive patients (41 arteries) and, as a historical control, compared the results with those from the conventional method in 25 consecutive patients (37 arteries) for the previous 3 years. We compared patient age, years of surgical experience, recipient vessel diameter, anastomotic events, and final patency. As a subanalysis, the same evaluations were performed separately for patients with Moyamoya disease. Furthermore, the time required for the lifting procedure was measured retrospectively.ResultsThe incidence of anastomotic events with the conventional method was 13.5% overall and 19% in those with Moyamoya disease. No adverse events occurred with the lifting method (P < 0.05). No statistically significant differences were found for the other factors, including final patency between the 2 groups. The time required for the lifting procedure averaged 1 minute, 15 seconds.ConclusionsUse of the lifting method widens and secures the ostium in a recipient vessel and greatly facilitates operability. We have found it to be a foolproof method enabling safe and reliable anastomosis even with narrow or thin vessels.Copyright © 2020 Elsevier Inc. All rights reserved.

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