Revascularization of the upper posterior circulation with the anterior temporal artery: an anatomical feasibility study

Abstract

OBJECTIVE In various disease processes, including unclippable aneurysms, a bypass to the upper posterior circulation (UPC) including the superior cerebellar artery (SCA) and posterior cerebral artery (PCA) may be needed. Various revascularization options exist, but the role of intracranial (IC) donors has not been scrutinized. The objective of this study was to evaluate the anatomical feasibility of utilizing the anterior temporal artery (ATA) for revascularization of the UPC. METHODS ATA-SCA and ATA-PCA bypasses were performed on 14 cadaver specimens. After performing an orbitozygomatic craniotomy and opening the basal cisterns, the ATA was divided at the M-M junction and mobilized to the crural cistern to complete an end-to-side bypass to the SCA and PCA. The length of the recipient artery between the anastomosis and origin was measured. RESULTS Seventeen ATAs were found. Successful anastomosis was performed in 14 (82%) of the ATAs. The anastomosis point on the PCA was 14.2 mm from its origin on the basilar artery. The SCA anastomosis point was 10.1 mm from its origin. Three ATAs did not reach the UPC region due to a common opercular origin with the middle temporal artery. The ATA-SCA bypass was also applied to the management of an incompletely coiled SCA aneurysm. CONCLUSIONS The ATA is a promising IC donor for UPC revascularization. The ATA is exposed en route to the proximal SCA and PCA through the pterional-orbitozygomatic approach. Also, the end-to-side anastomosis provides an efficient and straightforward bypass without the need to harvest a graft or perform multiple or difficult anastomoses.

Temporal Artery and Temporal Region Supplied by the Middle Cerebral Artery: An Anatomical Study

“…Although it rarely occurs in the distal segments of the TAs, especially in the presence of aneurysms of the TA branches that emerge as early branches, the neurovascular anatomical information of these structures is even more important 33–35 . The cortical branching arteries of this region, such as the TPA, ATA, and MTA, can also be proposed as a model for revascularisation-bypass operations 36–40 …”

“…[33][34][35] The cortical branching arteries of this region, such as the TPA, ATA, and MTA, can also be proposed as a model for revascularisation-bypass operations. [36][37][38][39][40] This study was performed on isolated hemispheres; therefore, it was not possible to obtain data regarding the sex and age of the donors. Additionally, only specimens that permitted adequate dissection and assessment of morphology to demonstrate the branching pattern of arteries were selected; therefore, the number of specimens with intact and filled arteries available for dissection and to demonstrate relationships was another limitation.…”

The oculomotor-tentorial triangle. Part 1: microsurgical anatomy and techniques to enhance exposure

“…Second, the lengths of the recipient SCA and PCA may be greater than those exposed in the interpeduncular cistern. 36 Third, as a bypass requires temporary trapping of the recipient artery, such a maneuver would endanger thalamoperforating arteries when performed in the interpeduncular cistern. On the other hand, the risk to thalamoperforating arteries is less during clipping of P 2A -PCA because it harbors fewer perforating arteries to the thalamus, although peduncular perforating and thalamogeniculate arteries may still be at risk.…”

“…1), which we call the oculomotor-tentorial triangle (OTT), has not been studied despite its frequent use to address various pathologies. 11,16,36,43 The purpose of this two-part report is to define the microsurgical anatomy of the OTT and assess ways to expand it (Part 1), and to summarize our clinical experience using the OTT to address various cerebrovascular pathologies, including aneurysms, cavernous malformations, and dural arteriovenous fistulas (Part 2).…”