Anatomic Feasibility of a Superficial Temporal Artery to Distal Anterior Cerebral Artery Bypass With a Parietal Branch Interposition Graft: The Superficial Temporal Artery Telescope Bypass

Authors

Sirin Gandhi, Department of Neurosurgery, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Arnau Benet, Department of Neurosurgery, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Halima Tabani, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Ali Tayebi Meybodi, Department of Neurosurgery, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Josep González Sánchez, Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, San Francisco, California, USA.
Lea Scherschinski, Department of Neurosurgery, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Visish M. Srinivasan, Department of Neurosurgery, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Michael T. Lawton, Department of Neurosurgery, Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.

Document Type

Article

Abstract

BACKGROUND AND OBJECTIVES: Revascularizing the postcommunicating segment of the anterior cerebral artery (ACA) using extracranial donor sites requires long interposition grafts. The superficial temporal artery (STA) is frequently used for extracranial-intracranial ACA revascularization. However, the length of either STA branch is not sufficient to reach the ACA with a proper caliber match, so an interposition graft is required. The aim of this study was to evaluate a bypass that uses the 2 main branches of the STA to reach the A3 (pericallosal) segment of the ACA. METHODS: The frontal and parietal branches of the STA were dissected from 10 cadaveric specimens. The middle internal frontal artery (MIFA) was exposed through an anterior interhemispheric approach. An interposition graft technique was applied using the parietal branch of the STA (pSTA) to connect the frontal branch of the STA (fSTA) with the MIFA. The bypass code is fSTA (E-Ec) pSTA + pSTA (E-Sc) MIFA. Measurements of length and caliber were taken at the anastomotic sites for the distal branches of the STA and the MIFA. RESULTS: The mean (SD) diameter of the MIFA measured 1.4 (0.2) mm, similar to the calibers of the frontal and parietal branches of the STA. The mean (SD) length of the end-to-side STA-MIFA bypass was 145.5 (7.4) mm, and the mean (SD) length of the donor-graft construct measured 204.2 (27.9) mm. This bypass design resulted in a surplus donor graft length of 38%. CONCLUSION: Using the pSTA as an interposition graft proved to be a successful technique for creating an STA-MIFA bypass, yielding excess donor graft length that facilitated an unstrained bypass construct. This approach offers several advantages, including a single skin incision, ample graft length, caliber compatibility, and a straightforward technical execution.

Publication Date

1-30-2024

Publication Title

Operative neurosurgery (Hagerstown, Md.)

E-ISSN

2332-4260

PubMed ID

38289088

Digital Object Identifier (DOI)

10.1227/ons.0000000000001060

Recommended Citation

Gandhi, Sirin; Benet, Arnau; Tabani, Halima; Tayebi Meybodi, Ali; González Sánchez, Josep; Scherschinski, Lea; Srinivasan, Visish M.; and Lawton, Michael T., "Anatomic Feasibility of a Superficial Temporal Artery to Distal Anterior Cerebral Artery Bypass With a Parietal Branch Interposition Graft: The Superficial Temporal Artery Telescope Bypass" (2024). Neurosurgery. 1984.
https://scholar.barrowneuro.org/neurosurgery/1984