title: Arachnoid Membrane Suturing for Prevention of Subdural Fluid Collection in Extracranial-intracranial Bypass Surgery.
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.
  
  
  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.
  
  
  CONCLUSIONS
  Arachnoid suturing is simple, safe, and effective for prevention of subdural fluid collection in EC-IC bypass surgery, especially the vulnerable ischemic hemisphere.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Gun Woo
authors.initials: GW
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Sung Pil
authors.identifier: 0000-0003-0871-2371
authors.initials: SP
authors.lastname: Joo
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Tae Sun
authors.initials: TS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Hyung Sik
authors.initials: HS
authors.lastname: Moon
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Jang
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Bo Ra
authors.initials: BR
authors.lastname: Seo
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Jung Kil
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Jae Hyoo
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Korea.
authors.forename: Soo Han
authors.initials: SH
authors.lastname: Kim
keywords: Arachnoid suture; Extracranial-intracranial bypass surgery; Mass effect; Subdural hygroma