Arachnoid Membrane Suturing for Prevention of Subdural Fluid Collection in Extracranial-intracranial Bypass Surgery.
10.7461/jcen.2014.16.2.71
- Author:
Gun Woo KIM
1
;
Sung Pil JOO
;
Tae Sun KIM
;
Hyung Sik MOON
;
Jae Won JANG
;
Bo Ra SEO
;
Jung Kil LEE
;
Jae Hyoo KIM
;
Soo Han KIM
Author Information
1. Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea. nsjsp@chonnam.ac.kr
- Publication Type:Original Article
- Keywords:
Arachnoid suture;
Extracranial-intracranial bypass surgery;
Subdural hygroma;
Mass effect
- MeSH:
Arachnoid*;
Cerebral Arteries;
Cerebral Revascularization;
Cerebrospinal Fluid;
Female;
Follow-Up Studies;
Humans;
Membranes*;
Prospective Studies;
Subdural Effusion;
Sutures;
Temporal Arteries
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2014;16(2):71-77
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Water-tight closure of the dura in extracranial-intracranial (EC-IC) bypass is impossible because the superficial temporal artery (STA) must run through the dural defect. Consequently, subdural hygroma and subcutaneous cerebrospinal fluid (CSF) collection frequently occur postoperatively. To reduce these complications, we prospectively performed suturing of the arachnoid membrane after STA-middle cerebral artery (STA-MCA) and evaluated the clinical usefulness. MATERIALS AND METHODS: Between Mar. 2005 and Oct. 2010, extracranial-intracranial arterial bypass (EIAB) with/without encephalo-myo-synangiosis was performed in 88 cases (male : female = 53 : 35). As a control group, 51 patients (57 sides) underwent conventional bypass surgery without closure of the arachnoid membrane. Postoperative computed tomography (CT) scan was performed twice in three days and seven days later, respectively, for evaluation of the presence of subdural fluid collection and other mass lesions. RESULTS: The surgical result was excellent, with no newly developing ischemic event until recent follow-up. The additional time needed for arachnoid suture was five to ten minutes, when three to eight sutures were required. Post-operative subdural fluid collection was not seen on follow-up computed tomography scans in all patients. CONCLUSION: Arachnoid suturing is simple, safe, and effective for prevention of subdural fluid collection in EC-IC bypass surgery, especially the vulnerable ischemic hemisphere.
