• Toshikazu Kimura, Kenji Ibayashi, and Kensuke Kawai.
• Department of Neurosurgery, Japanese Red Cross Medical Centre, Shibuya-ku, Tokyo, Japan. Electronic address: tkim-tky@umin.ac.jp.
• World Neurosurg. 2018 May 1; 113: e650-e653.

BackgroundIn superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, there is a certain risk of intraoperative acute occlusion of the bypass that can cause operative complications.ObjectiveWe sought to assess the efficacy of resuturing at the same site after intraoperative acute occlusion of the bypass.MethodsIn total, 129 STA-MCA anastomosis operations were performed on 125 patients at our institution. The electronic medical records of each patient were reviewed to gather information regarding intraoperative occlusion events, and the operative videos and postoperative radiologic images were also reviewed.ResultsTwelve intraoperative acute occlusions were identified. In each case, resuturing was performed after cutting all knots, flushing the thrombus, and trimming the edges of the STAs. In 11 cases, indocyanine green videoangiography and/or Doppler sonography revealed patency during the operation, which was confirmed by postoperative magnetic resonance angiography. None of the 12 cases exhibited high-signal intensities in the MCA area on diffusion-weighted images.ConclusionIf intraoperative acute occlusion of STA-MCA anastomosis occurs, reanastomosis at the site should be the first option.Copyright © 2018 Elsevier Inc. All rights reserved.

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