Vascular reconstruction is often essential for the treatment of complex intracranial saccular or dissecting aneurysms. We describe the use of a short interposed graft using the saphenous vein or radial artery to connect the proximal side of the superficial temporal artery (STA) and the recipient's intracranial artery (e.g., the M2 or M3 segment of the middle cerebral artery or the A3 segment of the anterior cerebral artery). In this procedure, the STA and the short interposed graft are anastomosed in side-to-end fashion so that the distal side of the STA is preserved. In this way, the blood flow of the scalp skin flap is not disturbed.
Bypass surgery using a short interposed graft was performed between December 2007 and January 2014 in 7 patients with complex intracranial aneurysms requiring parent artery occlusion or trapping. All 7 patients demonstrated good recovery according to the Glasgow Outcome Scale. No newly developed neurological deficits related to bypass surgery were observed in any of the 7 patients, all of whom had good graft patency after surgery. No scalp skin problems were observed.
Short interposed grafting from the proximal side of the STA to the recipient intracranial artery without occlusion of the distal side of the STA is effective after occlusion of the parent artery. This “moderate flow bypass” technique may be a effective alternative to high-flow bypass surgery.