title: A simple bracing technique to correct kinking of arterial branches to avoid ischemic sequelae during neurovascular surgery.
abstract: BACKGROUND
  During microscopic procedures for neurovascular disease, we sometimes encounter kinking of arterial branches resulting in ischemic sequelae. A simple and useful technique that involves inserting a small, ball-like prosthesis made of oxidized cellulose or shredded Teflon with fibrin glue that corrects the arterial branch kinking and avoids subsequent compromise is reported.
  
  
  METHODS
  Between January and December 2014, three patients developed arterial kinking during microscopic procedures, including two in the caudal loop of the posterior inferior cerebellar artery during microvascular decompression for glossopharyngeal neuralgia and one in a branch of the middle cerebral artery (MCA) during clipping for an unruptured MCA aneurysm. Blood flow insufficiency was confirmed by microvascular Doppler ultrasonography (MDU) and indocyanine green (ICG) videoangiography. The prosthesis, which was made of shredded Teflon in two cases and oxidized cellulose in one case, was inserted into the crotch of the kinked arteries to correct the kinking of the arteries and restore the proper vascular shape and normal blood flow.
  
  
  RESULTS
  The small, ball-shaped prosthesis corrected the kinked arteries and maintained the proper shape, which was confirmed by ICG videoangiography and MDU during the operation and three-dimensional computerized tomography angiography postoperatively. Postoperatively, the patients did not manifest any ischemic sequelae related to the kinked arteries.
  
  
  CONCLUSIONS
  The insertion of prostheses with fibrin glue into the crotch of a kinked artery for repair is considered a simple and useful method for correcting a kinked artery that avoids ischemic sequelae.
authors: Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
authors: Yasushi
authors: Y
authors: Motoyama
authors: Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
authors: Yoshitaka
authors: Y
authors: Tanaka
authors: Ohnishi Neurological Center, Akashi, Japan.
authors: Pritam
authors: P
authors: Gurung
authors: Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
authors: Ichiro
authors: I
authors: Nakagawa
authors: Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
authors: Young-Soo
authors: YS
authors: Park
authors: Department of Neurosurgery, Nara Medical University, Kashihara, Japan.
authors: Hiroyuki
authors: H
authors: Nakase
keywords: Cerebral aneurysm; clipping; glossopharyngeal neuralgia; kinking; microvascular decompression; simple bracing technique