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31.07.2018 | Technical Note - Neurosurgical technique evaluation | Ausgabe 10/2018

Acta Neurochirurgica 10/2018

Repair of damaged cortical artery by direct micro-suture in surgical treatment of acute subdural hematoma: technical note

Zeitschrift:
Acta Neurochirurgica > Ausgabe 10/2018
Autoren:
Atsuhito Uneda, Koji Hirashita, Satoru Yabuno, Takahiro Kanda, Kenta Suzuki, Atsushi Matsumoto, Masatoshi Yunoki, Kimihiro Yoshino
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00701-018-3634-5) contains supplementary material, which is available to authorized users.
This article is part of the Topical Collection on Neurosurgical technique evaluation

Abstract

Background

In surgical treatment of acute subdural hematoma (ASDH), neurosurgeons frequently encounter bleeding from cortical arteries, which is usually controlled with bipolar coagulation. However, bipolar coagulation is associated with a risk of sacrificing the cortical artery, which may affect the prognosis of neurological symptoms when these cortical arteries supply critical areas. In this article, we describe microsurgical repair of damaged cortical arteries using a 10-0 nylon micro-suture in patients with arterial-origin ASDH.

Methods

After removal of the subdural hematoma, the exact bleeding point of the cortical artery was identified, and the 10-0 nylon suture stitches were placed on the arterial tear under a microscope. After completion of the micro-suture, vascular patency was confirmed by indocyanine green (ICG) videoangiography.

Results

From June 2015 through February 2017, microsurgical repair was performed for seven cortical arteries in six patients. All damaged arteries were located near the Sylvian fissure, and all tears were pinhole tears. The average blood flow occlusion time was 8 min (range, 0–15 min). The patency of all seven repaired arteries was successfully confirmed by ICG videoangiography. Postoperative cerebral infarction was not observed except in one patient with cerebral contusion and a history of severe head trauma.

Conclusions

The present report demonstrates that repair of a cortical artery by the 10-0 nylon micro-suture is a simple and safe method with a low risk of sacrificing the artery. This technique may be a good option in the surgical treatment of arterial-origin ASDH, especially when the accompanying cerebral contusion is minimal.

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Zusatzmaterial
Video 1 Actual procedure of cortical artery repair using 10–0 nylon micro-suture in Patient 3. (MP4 48,144 kb)
701_2018_3634_MOESM1_ESM.mp4
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