Posterior auricular artery-middle cerebral artery bypass for additional surgery of moyamoya disease

Posterior auricular artery as an alternative donor vessel for extracranial-intracranial bypass surgery

“…Sometimes the STA is not available for bypass surgery due to hypoplasia of the artery, division of the artery at previous craniotomy, damage of the artery during dissection, or it is already used for an intracranial bypass. In such cases, the PAA can be used as an alternative donor when it ascends to the temporoparietal area with a large enough diameter [8,16].…”

“…Our literature search resulted in three hits, of which one article was not relevant to the topic. The selected articles have both recently been published in neurosurgical journals and described a bypass of the PAA to the MCA [8,16]. An overview of the reported data, added with the data of the current report, is presented in Table 1.…”

“…An alternative method is connecting the external carotid artery (ECA) with an interposition graft (saphenous vein or radial artery) to the intracranial internal carotid artery (ICA) or MCA, which is mostly used for high-flow bypasses [3]. Other, rarely used, donor arteries are the occipital artery [7,12] or the posterior auricular artery (PAA) [8,16].…”

“…In these cases an interposition graft can be used as an alternative, but this technique has its risks and drawbacks [3]. Recently, the PAA w a su s e da sa na d d i t i o n a lb y p a s si nar e f r a c t o r yc a s eo f moyamoya disease [8]a n df o rar e v a s c u l a r i s a t i o np r o c edure [16], indicating that the PAA might be a potential candidate for a EC-IC bypass.…”

Rescue revision techniques for end-to-side anastomosis: Technical note

“…[123456] STA-MCA bypass, especially in patients with moyamoya disease, demands a higher level of technical skill because the recipient arteries are usually small and fragile. Although the success rate for STA-MCA bypass is high, immediate donor occlusion occurs in a small number of patients and anastomosis revision is necessary in such cases.…”