Rescue Strategy for Troublesome Situations Related to Recipient and Donor Arteries during Low-Flow Bypass Surgery.

Abstract

OBJECTIVE\nBypass surgery is one of vital neurosurgical armamentaria, however technically demanding. To introduce the representative troublesome cases related to the manipulation of donor (DAs) and recipient (RAs) arteries during low-flow extracranial-intracranial bypass.\n\n\nMETHODS\nFor the past 5 years, a total of 507 low-flow bypass surgeries were performed in patients with cerebral aneurysms, moyamoya diseases and intracranial atherosclerotic stenosis diseases. Perioperative frustrating situations were retrospectively reviewed and 6 representative cases were finally described.\n\n\nRESULTS\nThe first case was about the repeat microanastomosis due to the occlusion of the anastomotic segment by thrombus formation. The second case was about the repair of the DA injured by the thermal energy. The third case was about the direct repair of the DA damaged by a sharp knife. The fourth case was about the repeat microanastomosis due to the avulsion of the anastomotic segment. The fifth case was about lengthening the short DA with a nearby interposition graft. The sixth case was about the use of retrograde flow via the distal segment of DA due to the injury of the proximal segment of DA. In all patients, rescue procedures were successful and bypass flow was patent with no relevant complications.\n\n\nCONCLUSION\nIntraoperative accidents were frustrating, however, they were safely rescued without significant sequelae. Our experiences are expected to help young neurosurgeons handling their embarrassing situations.