caa a22 4500 606213589 CHVBK 20210128101048.0 cr unu---uuuuu 210128e20150101xx s 000 0 eng 10.1007/s00701-014-2282-7 doi (NATIONALLICENCE)springer-10.1007/s00701-014-2282-7 Surgical anatomy and preservation of the middle meningeal artery during bypass surgery for moyamoya disease [Elektronische Daten] [Satoshi Hori, Daina Kashiwazaki, Naoki Akioka, Tomohide Hayashi, Emiko Hori, Kimiko Umemura, Yukio Horie, Satoshi Kuroda] Background: The middle meningeal artery (MMA) is known to function as one of the important collateral routes in moyamoya disease. However, the anterior branch frequently courses within the lesser wing of the sphenoid bone and can easily be damaged during craniotomy for bypass surgery. This prospective study aimed to study the surgical anatomy of the MMA and to establish the technique to preserve it during bypass surgery for moyamoya disease. Methods: Twenty-two patients with moyamoya disease underwent STA-MCA anastomosis combined with indirect bypass on 27 sides. The anatomical relationship between the anterior branch of the MMA and lesser wing was classified into three types: the bridge, monorail, and tunnel types. During surgery, the lesser wing was carefully resected with a rongeur or high-speed diamond drill to preserve the anterior branch of the MMA. Results: The anterior branch of the MMA was classified into the bridge type in 5 sides (18.5%), monorail type in 10 sides (37.0%), and tunnel type in 12 sides (44.5%). Patient age was closely related to the anatomical findings (χ 2 test, p = 0.0168). Careful resection of the lesser wing with a rongeur could preserve bridge- and monorail-type MMAs (100 and 71.4%, respectively). However, drilling out of the lesser wing under a surgical microscope was essential to preserve the tunnel-type MMA. Intraoperative indocyanine green videoangiography was useful to confirm patency during surgery. Conclusions: It is essential to understand the surgical anatomy of the MMA around the pterion in order to preserve its anterior branch during bypass surgery for moyamoya disease. Springer-Verlag Wien, 2014 Moyamoya disease nationallicence Bypass surgery nationallicence Middle meningeal artery nationallicence Sphenoid bone nationallicence Hori Satoshi Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut Kashiwazaki Daina Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut Akioka Naoki Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut Hayashi Tomohide Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut Hori Emiko Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan aut Umemura Kimiko Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan aut Horie Yukio Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan aut Kuroda Satoshi Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut Acta Neurochirurgica Springer Vienna 157/1(2015-01-01), 29-36 0001-6268 157:1<29 2015 157 701 https://doi.org/10.1007/s00701-014-2282-7 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2282-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Hori Satoshi Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut NATIONALLICENCE 700 1- Kashiwazaki Daina Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut NATIONALLICENCE 700 1- Akioka Naoki Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut NATIONALLICENCE 700 1- Hayashi Tomohide Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut NATIONALLICENCE 700 1- Hori Emiko Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan aut NATIONALLICENCE 700 1- Umemura Kimiko Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan aut NATIONALLICENCE 700 1- Horie Yukio Department of Neurosurgery, Stroke Center, Saiseikai Toyama Hospital, Toyama, Japan aut NATIONALLICENCE 700 1- Kuroda Satoshi Department of Neurosurgery, Graduate School of Medicine and Pharmacological Science, University of Toyama, 2630 Sugitani, 930-0194, Toyama, Japan aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/1(2015-01-01), 29-36 0001-6268 157:1<29 2015 157 701