Abstract
Background
Double superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery has typically involved more than one linear incision. In this report, we demonstrate how the procedure can be performed through a single linear skin incision over the parietal branch of the STA.
Methods
Initial dissection of the parietal branch and creation of a subcutaneous cavity along the frontal branch were performed using the conventional microscopic method. Detailed additional dissection and isolation of the frontal branch were accomplished with the aid of an endoscopic retractor.
Results
This procedure was performed in five patients for harvesting of approximately 8- and 5-cm lengths of the parietal and frontal branches, respectively. The resultant lengths of the harvested vessels were sufficient for anastomotic revascularization of MCA recipient arteries in both the frontal and temporal lobes.
Conclusion
This method can be safely performed with achievement of a less invasive dissection of the STA and an overall improved cosmetic outcome.
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Comment
Within the last quarter of a century or so, all studies have failed to show that STA-MCA bypasses are superior to pharmaceutical therapy in preventing ischemic events in patients with TIA or strokes. However, there is still an increasing role for EC-IC bypasses in selected patients with otherwise untreatable aneurysms, mainly when sacrifice of the MCA or ICA is necessary. The simpler the method, the better the results may be as there are fewer steps with which to have potential problems. Therefore, the enthusiasm for performing high-flow bypasses with often complicated methods has decreased and has turned to standard STA-MCA bypasses, which, in fact, often are enough for the patients. As endoscopic techniques are developing it is natural also to apply them successfully in bypasses, as the authors show. With experience, the procedure is not so time consuming, especially when combined with use of the operating microscope. The cosmetic results are better with shorter incisions, and perhaps there is also less risk of poor healing of the incision itself as all branches, also those feeding the skin, are harvested. We still need to develop even simpler techniques, especially for high-flow bypasses that can be performed quickly and safely even under local anesthesia in patients who are often sick and compromised in many ways.
Mika Niemelä
Juha Hernesniemi
Helsinki, Finland
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Tamura, Y., Aoki, A., Yamada, Y. et al. Dissection of both frontal and parietal branches of the superficial temporal artery for bypass surgery through a single linear skin incision. Acta Neurochir 153, 1645–1648 (2011). https://doi.org/10.1007/s00701-011-1035-0
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DOI: https://doi.org/10.1007/s00701-011-1035-0