Surgical Technique for Direct Anastomosis to a Fine Recipient Artery with a Diameter of 0.3 mm or Less in Moyamoya Disease

Abstract

In our institution, 346 operations on 175 moyamoya disease patients aged less than 16 years, and 188 operations on 121 moyamoya disease patients aged 16 years and over have been performed between March 1, 2001 and December 31, 2013. Direct anastomosis was used in 173 operations in the former group and 122 operations in the latter. Five procedures, all in the former group, which had a recipient artery of diameter 0.3 mm or less, were performed with direct anastomosis. Under such conditions, direct anastomosis is possible, and we discuss its strategy here.Fishmouth opening of a fine recipient should be performed by a single incision technique and should be as small as possible.The tip of the microneedle should be moved to the inner surface of the arterial wall at the time when the surface of the brain is situated at the highest level, and it should pass the arterial wall when the surface of the brain moves downward. Finally, definite fixation and fine movement of a microneedle is mandatory for its passing of a recipient's arterial wall.