Superficial temporal artery (STA)-to-middle cerebral artery (MCA) anastomosis is sometimes effective for moyamoya disease and chronic ischemic disease. Surgical indications are decided for internal carotid artery or middle cerebral artery occlusive disease with misery perfusion. The surgery must be performed safely to reduce the risk of complications. Forty patients underwent extracranial-intracranial bypass between July 2010 and July 2017 (30 men and 10 women; 28 patients had ischemic disease and 12 patients had moyamoya disease). We monitored the motor-evoked potential (MEP), micro-Doppler imaging, and indocyanine green (ICG) staining for STA-MCA bypass surgery. We determined the cortical MEP for all the cases. We used the MEP and micro-Doppler image for identifying a safe and effective recipient artery before anastomosis. During anastomosis, the MEP was monitored every minute. After anastomosis, we checked the micro-Doppler and ICG findings for the patency of the anastomosis. We think MEP is highly useful for performing STA-MCA bypass surgery safely and that micro-Doppler imaging and ICG staining are effective for evaluating postoperative bypass patency. We could perform STA-MCA bypass safely for using several modalities.
