• Gang Wang, Songtao Qi, Guozhong Zhang, Yunyu Wen, Mingzhou Li, Shichao Zhang, Yanyi Yin, Orazmyradov Berdimyrat, and Wenfeng Feng.
• Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
• World Neurosurg. 2020 Jul 1; 139: 294-297.

ObjectiveTo introduce a membrane retraction technique that can provide good exposure of deep-seated recipient arteries in cortical sulci and simplify the anastomosis procedure.MethodsOnly those adult patients with moyamoya disease who underwent superficial temporal artery to middle cerebral artery bypass surgery during which the suitable recipient arteries were located deep in cortical sulci were included in this retrospective study. By placing 10-0 prolene sutures to the arachnoid membrane of the 2 banks of sulcus, arachnoid retraction was applied to pull the sulcus apart and then the deep-seated recipient arteries were exposed. Standard end-to-side anastomosis was completed. The mean occlusion time and successful rate were recorded and compared with those of the normal procedure.ResultsFrom June to November 2019, 124 superficial temporal artery to middle cerebral artery bypass surgeries for the treatment of moyamoya disease were performed in Nanfang Hospital. The membrane retraction technique was used in 5 patients (5/110, 4.5%) and the success rates were 100%. The mean temporary occlusion time was 27.2 minutes. No procedure-related complications were observed. All patients recovered uneventfully. The postoperative angiograms confirmed good patency of bypass grafts in all 5 cases.ConclusionsThe membrane retraction technique is an effective and safe method for the treatment of adult patients with moyamoya disease with deep-seated recipient arteries within the sulci.Copyright © 2020 Elsevier Inc. All rights reserved.

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