Superficial Temporal Artery-Middle Cerebral Artery Double Bypass Using a Single Superficial Temporal Artery Branch: A Technical Case Report

Abstract

A superficial temporal artery (STA)-middle cerebral artery (MCA) double bypass is performed using two STA branches (frontal and parietal); however, one branch may be absent. We report a case of STA-MCA double bypass using one STA branch. A 67-year-old woman presented with right hemiparesis and motor aphasia secondary to left M1 occlusion. Despite optimal medical therapy, the neurological symptoms worsened after admission. IMP-single photon emission computed tomography revealed reduced cerebral blood flow in the left MCA. STA-MCA double bypass was planned; however, the STA showed only a parietal branch, and double bypass was attempted using only the parietal branch. Following parietal branch harvest, the vessel was divided into two segments. We performed STA-STA anastomosis (end-to-side) and created a Y-shaped donor graft (grafting bypass). Each end was anastomosed (end-to-side) to an MCA branch on the frontal and temporal lobes. The patient showed no new neurological deficit postoperatively. Postoperative magnetic resonance imaging and angiography revealed no ischemic lesion and good bypass patency. This method involves creation of end-to-side anastomoses in all cases, which is a significant advantage of this approach. Most bypass procedures include end-to-side anastomosis, and many neurosurgeons are familiar with this technique. This method may be useful in patients with a single STA branch.