Usefulness of a Bicoronal Skin Incision Right above the Bilateral Frontal Branches of the Superficial Temporal Arteries in a Superficial Temporal Artery-Anterior Cerebral Artery (A3) Anastomosis

Abstract

Introduction: As revascularization of the anterior cerebral artery (A3) requires a longer graft than that of the middle cerebral artery, the design of the skin incision requires some ingenuity. Bilateral frontal craniotomy and a superficial temporal artery–anterior cerebral artery (A3) anastomosis were performed using a bicoronal skin incision right above the frontal branches of the bilateral superficial temporal arteries.

Case: A 73-year-old woman presented with a right distal anterior cerebral artery aneurysm and severe stenosis of the bilateral anterior cerebral arteries. Clipping and revascularization of the bilateral anterior cerebral arteries [A3–A3 bypass and left superficial temporal artery–anterior cerebral artery (A3) anastomosis] were performed. No facial nerve paralysis was observed in the postoperative period.

Conclusion: Facial nerve paralysis is unlikely with a skin incision above the Pitanguy’s line, and a bicoronal skin incision right above the frontal branches of the bilateral superficial temporal arteries is useful for the bilateral frontal craniotomy and anterior cerebral artery (A3) anastomosis.