• Juan Carlos Gomez-Vega, Nakao Ota, Muhammad Kusdiansah, Kosumo Noda, Hiroyasu Kamiyama, and Rokuya Tanikawa.
• Department of Neurosurgery, Far East Neurosurgical Institute, Sapporo Teishinkai Hospital, Stroke Center, Sapporo, Japan.
• World Neurosurg. 2024 Sep 1; 189: 172517-25.

BackgroundMicroanastomosis presents a challenge in neurosurgical procedures, requiring specialized skills. Regular practice outside the operating room is crucial. This study aims to provide a detailed description of the side-to-side anastomosis technique and analyze its advantages in preventing failures compared with other variations.MethodsWe examined the technique, characteristics, and outcomes of side-to-side bypass procedures for complex aneurysms in the anterior cerebral artery territory at our institution over the past decade. We compared our technique with those described in the literature by other groups.ResultsThe Far East Neurosurgical Institute (FENI) technique was used in 15 patients, with 17 side-to-side anastomoses performed. The average anastomosis time was 27.5 minutes, with 100% patency in follow-up. Our technique demonstrated safety and effectiveness in treating intracranial aneurysms, yielding satisfactory short- and long-term functionality outcomes. We highlight the importance of maintaining a curvilinear arteriotomy shape, at least 3 times the diameter of the artery, and utilizing an interrupted suturing technique on the anterior wall.ConclusionsThis paper presents the first comprehensive description of the side-to-side anastomosis technique, supported with images and videos for training and replicability. Our technique enhances flow dynamics and reduces the risk of acute thrombus formation. Training in simulators and microsurgery practice centers outside the operating room is essential for acquiring and refining microsurgical skills.Copyright © 2024. Published by Elsevier Inc.

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