{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T17:18:56Z","timestamp":1772126336755,"version":"3.50.1"},"reference-count":12,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,9]]},"abstract":"\nOBJECT<\/jats:title>\nThe authors experienced an intriguing phenomenon in 2 adult patients with moyamoya disease. Mouth opening caused reversible occlusion of the donor superficial temporal artery (STA), and the patients exhibited transient cerebral ischemic symptoms. The aim of this study was to assess the incidence of such occlusion and the mechanism of this phenomenon.<\/jats:p><\/jats:sec>\n\nMETHODS<\/jats:title>\nTwelve consecutive adult patients with moyamoya disease (15 affected sides) who underwent STA\u2013middle cerebral artery anastomosis were included in this study. Ultrasound examination was performed more than 3 months postoperatively to determine whether mouth opening affected blood flow of the donor STA and led to any ischemic symptoms within 1 minute. Computed tomography angiography was performed during both mouth opening and mouth closing, when blood flow changes of the donor STA were recognized.<\/jats:p><\/jats:sec>\n\nRESULTS<\/jats:title>\nUnder wide mouth opening, steno-occlusion of the donor STA occurred in 5 of 15 sides (33.3%). On 1 side (6.7%), complete occlusion induced ischemic symptoms. Steno-occlusion occurred by at least 2 mechanisms: either the stretched temporalis muscle pushed the donor STA against the edge of the bone window, or the redundant donor STA kinked when the muscle was stretched.<\/jats:p><\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nEven with temporary occlusion of the donor STA, ischemic symptoms seem to rarely occur. However, to avoid the \u201cbig bite ischemic phenomenon,\u201d the authors recommend securing a sufficient distance between the donor STA and the edge of the bone window and avoiding a redundant course of the donor STA within the muscle layer.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.jns141805","type":"journal-article","created":{"date-parts":[[2015,4,24]],"date-time":"2015-04-24T14:00:02Z","timestamp":1429884002000},"page":"670-675","source":"Crossref","is-referenced-by-count":8,"title":["Reversible occlusion of donor vessel caused by mouth opening after superficial temporal artery\u2013middle cerebral artery anastomosis in adult moyamoya patients"],"prefix":"10.3171","volume":"123","author":[{"given":"Toshiro","family":"Katsuta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Abe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Miki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tooru","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns141805","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1056\/NEJM198511073131904","article-title":"Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. 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