• Kenyu Hayashi, Ken Uekawa, Takayuki Kawano, Yuki Ohmori, Toshihiro Amadatsu, Yushin Takemoto, and Akitake Mukasa.
• Department of Neurosurgery, Kumamoto University School of Medicine, Honjo, Kumamoto, Japan.
• World Neurosurg. 2019 Jul 1; 127: e864-e872.

BackgroundThe superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis (STA-MCA bypass) currently is performed to prevent atherosclerotic occlusive cerebrovascular disease. However, the benefits of the bypass surgery remain controversial. To ensure consistent surgical benefits, understanding the mechanisms of perioperative cerebral infarction (CI) is required. Moreover, appropriate patient selection procedures must be determined to decrease the rate of perioperative stroke. We retrospectively investigated patients who underwent bypass surgery at our institution and determined that the patients who presented with cortical venous reddening after anastomosis during the surgery developed perioperative CI.MethodsA total of 45 consecutive patients who underwent bypass surgery were retrospectively investigated. Twenty-five of the 45 patients underwent bypass for atherosclerotic occlusion or stenosis of the internal carotid artery or middle cerebral artery. Preoperative iodine-123-N-isopropyl-iodoamphetamine single-photon emission computed tomography was performed with and without acetazolamide administration. Change in color of the cortical veins was observed on recorded surgical videos, and its correlation with perioperative CI was investigated.ResultsWe experienced 2 cases of perioperative extensive CI at a region remote from the site of anastomosis. In both cases, retrospective investigation of surgical videos demonstrated reddening of cortical veins soon after the anastomosis procedure. Of all 45 patients, postoperative CI and venous reddening were observed in only these 2 cases.ConclusionsWe determined that patients presenting with cortical venous reddening after anastomosis developed perioperative CI. Cortical venous reddening may be an important predictor for the occurrence of CI after STA-MCA bypass surgery for patients with atherosclerotic occlusive cerebrovascular disease.Copyright © 2019 Elsevier Inc. All rights reserved.

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