Skip to main content
Log in

Proximal superficial temporal artery to proximal middle cerebral artery bypass using a radial artery graft: an anatomic approach

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

We present the use of radial artery graft for bypass of the proximal superficial temporal artery to the proximal middle cerebral artery. Six adult cadaver sites were used bilaterally. After apterional incision, 2×2-cm minicraniectomy was performed which began 2 cm behind the zygomatic process of the frontal bone. The superficial temporal artery was transsected before exposing the zygomatico-orbital artery branch. The proximal side of the radial artery graft was anastomosed end-to-end to the proximal superficial temporal artery and the distal side end-to-side to the proximal middle cerebral artery. The mean calibers of the proximal superficial temporal artery and largest trunk of the middle cerebral artery were 2.25±0.35 mm and 2.3±0.3 mm, respectively. The average graft length was 85±5.5 mm. We conclude that such bypasses are simpler than proximal middle cerebral artery revascularization using long vein grafts. This method proves that the caliber of the proximal superficial temporal artery is more suited to providing sufficient flow than the distal superficial temporal artery, and the graft is short. Such bypasses to the middle cerebral artery may be an alternative to those from the distal superficial temporal artery or extracranial carotid artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1a, b
Fig. 2a, b

Similar content being viewed by others

References

  1. Al-Mefty O, Khalil N, Elwany MN, Smith RR (1990) Shunt for bypass graft of the cavernous carotid artery: an anatomical and technical study. Neurosurgery 27:721–727

    CAS  PubMed  Google Scholar 

  2. Ausman JI, Nicoloff DM, Chou SN (1978) Posterior fossa revascularization: anastomosis of vertebral artery to PICA with interposed radial artery graft. Surg Neurol 9:281–286

    CAS  PubMed  Google Scholar 

  3. Ausman JI, Pearce JE, de los Reyes RA, Schanz G (1983) Treatment of a high extracranial carotid artery aneurysm with CCA-MCA bypass and carotid ligation. Case report. J Neurosurg 58:421–424

    CAS  PubMed  Google Scholar 

  4. Candon E, Canovas F, Kabbaj J, Pieuchot P, Bonnel F, Frerebeau P (1998) Anatomic basis for the treatment of aneurysms of the upper cervical segment of the internal carotid artery by extracranial cervico-petrous bypass with inverted “in situ” saphenous vein graft. Surg Radiol Anat 20:1–6

    CAS  PubMed  Google Scholar 

  5. Cantore G, Santoro A, Da Pian R (1999) Spontaneous occlusion of supraclinoid aneurysms after the creation of extra-intracranial bypasses using long grafts: report of two cases. Neurosurgery 44:219–220

    Google Scholar 

  6. Collice M, Arena O, Fontana RA (1986) Superficial temporal artery to proximal middle cerebral artery anastomosis: clinical and angiographic long term results. Neurosurgery 19:992–997

    CAS  PubMed  Google Scholar 

  7. D’Alise MD, Vardiman AB, Kopitnik TA Jr, Batjer HH (1996) External carotid-to-middle cerebral bypass in the treatment of complex internal carotid injury. J Trauma 40:452–455

    CAS  PubMed  Google Scholar 

  8. Diaz FG, Ausman JI, Pearce JE (1982) Ischemic complications after combined internal carotid artery occlusion and extracranial-intracranial anastomosis. Neurosurgery 10:563–570

    PubMed  Google Scholar 

  9. Diaz FG, Pearce JE, Ausman JI (1985) Complications of cerebral revascularization with autogenous vein grafts. Neurosurgery 17:271–276

    CAS  PubMed  Google Scholar 

  10. Eliason JL, Netterville JL, Guzman RJ, Passman MA, Naslund TC (2002) Skull base resection with cervical-to-petrous carotid artery bypass to facilitate repair of distal internal carotid artery lesions. Cardiovasc Surg 10:31–37

    Article  PubMed  Google Scholar 

  11. Hopkins LN, Grand W (1979) Extracranial-intracranial arterial bypass in the treatment of aneurysms of the carotid and middle cerebral arteries. Neurosurgery 5:21–31

    PubMed  Google Scholar 

  12. Ishikawa T, Kamiyama H, Houkin K, Takahashi A, Iwasaki Y, Abe H (1995) Postsurgical observations of mean hemispheric cerebral blood flow with patients receiving high-flow EC-IC bypass using a radial artery graft (preliminary report, one-year observation of 10 hemispheres). Surg Neurol 43:500–509

    Article  CAS  PubMed  Google Scholar 

  13. Kamiyama H, Abe H, Yamauchi T, Kuroda S, Kobayashi N, Ito F, Mabuchi S, Nomura M (1992) Use of a radial artery graft in STA-MCA anastomosis and other recent improvements in reconstructive surgery. Jpn J Neurosurg 1:4–13

    Google Scholar 

  14. Karabulut AK, Ustun ME, Uysal II, Salbacak A (2001) Saphenous vein graft for bypass of the maxillary to supraclinoid internal carotid artery: an anatomical short study. Ann Vasc Surg 15:548–552

    Article  CAS  PubMed  Google Scholar 

  15. Lang J (1995) Skull base and related structures. Atlas of clinical anatomy. Schattauer, Stuttgart, pp 122–123

  16. Little JR, Furlan AJ, Bryerton B (1983) Short vein grafts for cerebral revascularization. J Neurosurg 59:384–388

    CAS  PubMed  Google Scholar 

  17. Lougheed WM, Marshall BM, Hunter M, Michel ER, Sandwith-Smyth H (1971) Common carotid to intracranial internal carotid bypass venous graft. Technical note. J Neurosurg 34:114–118

    CAS  PubMed  Google Scholar 

  18. Mabuchi S, Kamiyama H, Abe H (1993) Distal ligation and revascularization from external carotid to vertebral artery with radial artery graft for treatment of extracranial vertebral artery dissection. Report of a case. Acta Neurochir 125:192–195

    CAS  Google Scholar 

  19. Marano SR, Fischer DW, Gaines C, Sonntag VK (1985) Anatomical study of the superficial temporal artery. Neurosurg 16:786–790

    CAS  Google Scholar 

  20. Morimoto T, Sakaki T, Kakizaki T, Takemura K, Kyoi K, Utsumi S (1988) Radial artery graft for an extracranial-intracranial bypass in cases of internal carotid aneurysms. Report of two cases. Surg Neurol 30:293–297

    CAS  PubMed  Google Scholar 

  21. Nishikawa M, Hashi K, Shiguma M (1979) Middle meningeal-middle cerebral artery anastomosis for cerebral ischemia. Surg Neurol 12:205–208

    CAS  PubMed  Google Scholar 

  22. Numata T, Konno A, Takeuchi Y, Katahashi T, Yuza J, Hanazawa T, Ono J (1997) Contralateral external carotid-middle cerebral artery bypass for carotid artery resection. Laryngoscope 107:665–670

    Google Scholar 

  23. Sekhar LN, Schramm VI Jr, Jones NF, Yonas H, Horton J, Latchaw RE, Curtin H (1986) Operative exposure and management of the petrous and upper cervical internal carotid artery. Neurosurgery 19:967–982

    CAS  PubMed  Google Scholar 

  24. Sekhar LN, Sen CN, Jho HD (1990) Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 72:35–41

    CAS  PubMed  Google Scholar 

  25. Sekhar LN, Wright DC, Olding M (1999) Brain revascularization by saphenous vein and radial artery bypass graft. In: Sekhar LN, Olivera ED (eds) Cranial microsurgery. Thieme, New York, pp 581–600

  26. Sen C, Sekhar LN (1992) Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases. Neurosurgery 30:732–743

    CAS  PubMed  Google Scholar 

  27. Spetzler RF, Chater N (1974) Occipital artery-middle cerebral artery anastomosis for cerebral artery occlusive disease. Surg Neurol 2:235–238

    CAS  PubMed  Google Scholar 

  28. Spetzler RF, Schuster H, Roski RA (1980) Elective extracranial-intracranial arterial bypass in the treatment of inoperable giant aneurysms of the internal carotid artery. J Neurosurg 53:22–27

    CAS  PubMed  Google Scholar 

  29. Spetzler RF, Fukushima T, Martin N, Zabramski JM (1990) Petrous carotid-to-intradural carotid saphenous vein graft for intracavernous giant aneurysm, and occlusive cerebrovascular disease. J Neurosurg 73:496–501

    CAS  PubMed  Google Scholar 

  30. Story JL, Brown WE Jr, Eidelberg E, Arom KV, Stewart JR (1978) Cerebral revascularization: common carotid to distal middle cerebral artery bypass. Neurosurgery 2:131–135

    CAS  PubMed  Google Scholar 

  31. Sundt TM Jr, Piepgras DG, Houser OW, Campbell JK (1982) Interposition saphenous vein grafts for advanced occlusive disease and large aneurysms in the posterior circulation. J Neurosurg 56:205–215

    PubMed  Google Scholar 

  32. Sundt TM Jr, Piepgras DG, Marsh WR, Fode NC (1986) Saphenous vein bypass grafts for giant aneurysms and intracranial occlusive disease. J Neurosurg 65:439–450

    PubMed  Google Scholar 

  33. Tachibana E, Suzuki Y, Harada T, Saito K, Gupta SK, Yoshida J (2000) Bypass surgery using a radial artery graft for bilateral extracranial carotid artery occlusion. Neurosurg Rev 23:52–55

    Article  CAS  PubMed  Google Scholar 

  34. Umansky F, Juarez SM, Dujovny M, Ausman JI, Diaz FG, Gomes F, Mirchandani HG, Ray WJ (1984) Microsurgical anatomy of the proximal segments of the middle cerebral artery. J Neurosurg 61:458–467

    CAS  PubMed  Google Scholar 

  35. Vishteh AG, Marciano FF, David CA, Schievink WI, Zabramski JM, Spetzler RF (1998) Long-term graft patency rates and clinical outcomes after revascularization for symptomatic traumatic internal carotid artery dissection. Neurosurgery 43:761–768

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mustafa Büyükmumcu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Büyükmumcu, M., Güney, Ö., Üstün, M.E. et al. Proximal superficial temporal artery to proximal middle cerebral artery bypass using a radial artery graft: an anatomic approach. Neurosurg Rev 27, 185–188 (2004). https://doi.org/10.1007/s10143-003-0317-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-003-0317-2

Keywords

Navigation