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In genetic studies of cerebrovascular diseases, the optimal vessels to use as controls remain unclear. Our goal is to compare the transcriptomic profiles among 3 different types of control vessels: superficial temporal artery (STA), middle cerebral arteries (MCA), and arteries from the circle of Willis obtained from autopsies (AU). We examined the transcriptomic profiles of STA, MCA, and AU using RNAseq. We also investigated the effects of using these control groups on the results of the comparisons between aneurysms and the control arteries. Our study showed that when comparing pathological cerebral arteries to control groups, all control groups presented similar responses in the activation of immunological processes, the regulation of intracellular signaling pathways, and extracellular matrix productions, despite their intrinsic biological differences. When compared to STA, AU exhibited upregulation of stress and apoptosis genes, whereas MCA showed upregulation of genes associated with tRNA/rRNA processing. Moreover, our results suggest that the matched case–control study design, which involves control STA samples collected from the same subjects of matched aneurysm samples in our study, can improve the identification of non-inherited disease-associated genes. Given the challenges associated with obtaining fresh intracranial arteries from healthy individuals, our study suggests that using MCA, AU, or paired STA samples as controls are feasible strategies for future large-scale studies investigating cerebral vasculopathies. However, the intrinsic differences of each type of control should be taken into consideration when interpreting the results. With the limitations of each control type, it may be most optimal to use multiple tissues as controls. [ABSTRACT FROM AUTHOR]

Background: Cerebral Revascularization (CR) remained an indispensable arm in the neurosurgical arsenal, especially managing symptomatic hemisphere with misery perfusion (SHMP). Method: We described an a mid-aged gentleman diagnosed with progressive middle cerebral steno-occlusion following carotid endarterectomy by employing individualized arterial reconstruction with tentative clamping method (TCM) under supervision of intraoperative monitoring. An operative video was also accompanied to demonstrate further details. Conclusion: The optimal treatment strategy for SHMP should be tailored by individuals. The risk of postoperative adverse sequel can be minimized and improved neuro-cognitive status was accomplished with an aid of TCM for such prophylactic procedure. Clinical trial registration: NA. [ABSTRACT FROM AUTHOR]

Purpose: Superficial temporal artery to middle cerebral artery (STA-MCA) direct bypass surgery is the most common surgical procedure to treat moyamoya disease (MMD). Here, we aim to compare the performance of the 3D exoscope in bypass surgery with the gold standard operative microscope. Methods: All direct STA-MCA bypass procedures performed at a single university hospital for MMD between 2015 and 2023 were considered for inclusion. Data were retrospectively collected from patient files and surgical video material. From 2020 onwards, bypass procedures were exclusively performed using a digital three-dimensional exoscope as visualization device. Results were compared with a microsurgical bypass control group (2015–2019). The primary endpoint was defined as total duration of surgery, duration of completing the vascular anastomosis (ischemia time), bypass patency, number of stiches to perform the anastomosis, added stiches after leakage testing of the anastomosis and the Glasgow outcome scale (GOS) at last follow-up as secondary outcome parameter. Results: A total of 16 consecutive moyamoya patients underwent 21 STA-MCA bypass procedures. Thereof, six patients were operated using a microscope and ten patients using an exoscope (ORBEYE® n = 1; AEOS® n = 9). Total duration of surgery was comparable between devices (microscope: 313 min. ± 116 vs. exoscope: 279 min. ± 42; p = 0.647). Ischemia time also proved similar between groups (microscope: 43 min. ± 19 vs. exoscope: 41 min. ± 7; p = 0.701). No differences were noted in bypass patency rates. The number of stiches per anastomosis was similar between visualization devices (microscope: 17 ± 4 vs. exoscope: 17 ± 2; p = 0.887). In contrast, more additional stiches were needed in microscopic anastomoses after leakage testing the bypass (p = 0.035). Conclusion: Taking into account the small sample size, end-to-side bypass surgery for moyamoya disease using a foot switch-operated 3D exoscope was not associated with more complications and led to comparable clinical and radiological results as microscopic bypass surgery. [ABSTRACT FROM AUTHOR]

Hollow temples are not typically considered aesthetically pleasing, and hollowness worsens with the aging process. When filling this region with fillers, there are several anatomical considerations, with injection techniques varying depending on the layer targeted. Specifically, injections between the superficial temporal fascia and the superficial layer of the deep temporal fascia are performed using a cannula, while periosteal layer injections involve the use of a needle to reach the bone before inserting fillers. Detailed anatomical insights encompass the boundaries of the temporal fossa and cautionary notes regarding blood vessels, supported by specific studies on veins and arteries in the temporal region. Complications, including vessel injuries, are discussed alongside an exploration of various injection techniques. This review provides a comprehensive exploration of anatomical considerations and the specific methodologies employed in temple augmentation with fillers. [ABSTRACT FROM AUTHOR]

Background: To describe the concept of a protective superficial temporal artery-middle cerebral artery (STA-MCA) bypass performed prior to endoscopic transnasal cavernous sinus (CS) lesion resection in order to reduce the risk of perioperative cerebral ischemia due to internal carotid artery (ICA) vasospasm, occlusion, and even injury. Method: We illustrated the procedure of a 14-year-old female accepting a protective STA-MCA bypass with endoscopic transnasal CS lesion resection. Conclusion: A protective bypass may be a prophylactic strategy in selected endoscopic transnasal CS surgery cases, particularly where the diagnosis is uncertain, or the risk of ICA injury or occlusion is high. [ABSTRACT FROM AUTHOR]

Transient neurological events (TNEs) occur after bypass surgery in Moyamoya disease (MMD); however, their pathology remains unknown. To elucidate the pathophysiology of TNEs, we investigated their relationship with perioperative superficial temporal artery (STA) blood flow volume, which was evaluated using ultrasonography. Forty-nine patients with MMD, who underwent direct bypass surgery, were included and stratified into TNE and non-TNE groups, respectively. The STA blood flow volume was evaluated at four time points (preoperatively and 2–4, 7, and 10–14 days postoperatively), and a change in volume during the postoperative period was defined as a flow volume mismatch. We investigated the association between ultrasonographic findings of flow volume mismatch and TNEs and magnetic resonance imaging findings, such as the cortical hyperintensity belt (CHB) sign, using univariate and path analyses. The STA blood flow volume increased immediately postoperatively, gradually decreasing over time, in both groups. The TNE group showed a significant increase in blood flow volume 2–4 days postoperatively (P = 0.042). Flow volume mismatch was significantly larger in the TNE group than in the non-TNE group (P = 0.020). In the path analysis, STA flow volume mismatch showed a positive association with the CHB sign (P = 0.023) and TNEs (P = 0.000). Additionally, the CHB sign partially mediated the association between STA flow volume mismatch and TNEs. These results suggest that significantly high STA blood flow volume changes occurring during the acute postoperative period after direct bypass surgery in MMD are correlated with TNEs and the CHB sign, suggesting involvement in the pathophysiology of TNEs. [ABSTRACT FROM AUTHOR]

Background: Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass is a critical treatment for moyamoya disease and steno-occlusive cerebrovascular disease. Combined bypass (direct + indirect) optimizes the chance of durable flow augmentation but can complicate wound closure from tissue disruption. Methods: We describe our technique for combined direct and indirect (encephaloduromyosynangiosis; EDAMS) STA-MCA bypass using a hinged bone flap. In addition to a direct bypass, EDAMS provides multiple sources for indirect revascularization. The hinged bone flap gently approximates the muscle and pia for secondary vascular ingrowth. Conclusions: Combined STA-MCA bypass with a hinged bone flap safely maximizes revascularization potential. [ABSTRACT FROM AUTHOR]

Objective: Temporoparietal fascia is important for auricular reconstruction or repair after auricular reconstruction. Thus, the course of the superficial temporal artery (STA) is of vital importance to prevent destruction of the artery. The purpose of this study was to evaluate the course of the superficial temporal artery in patients with congenital microtia and its relationship with remnants. Methods: This was a prospective study. Patients with microtia who underwent auricular reconstruction in our hospital from January 2021 to July 2021 underwent ultrasound examination of the STA. Under the guidance of ultrasound, the superficial temporal artery and its branches were located and marked on the body surface before the operation, ranging from the zygomatic arch plane to the temporal parietal artery. In addition, the hemodynamics of the STAs were recorded. Results: A total of 108 patients with microtia were collected, including 106 patients with unilateral microtia and 2 patients with bilateral microtia. There were 82 cases of lobule type, 21 cases of small concha type, and 7 cases of large concha type. The superficial temporal artery in 103 ears was divided into two branches: the parietal branch and the frontal branch, but there was only one branch in 7 ears. The parietal branch was absent in 5 cases, and the frontal branch was absent in 2 cases. In most of the ears, the bifurcation was located above the zygomatic arch plane. Only in 2 ears was the bifurcation located below the zygomatic arch, and the most common bifurcation position was the eyebrow arch level (43.7%). Regarding the shortest distances between the STA and the remnant, they were less than 0.5 cm in 47 ears, more than 1 cm in 30 ears, and 0.5 cm to 1 cm in 33 ears. Conclusion: The course of STA varied greatly and there were occasional single branches. The distances between the STA and remnant were often near 0.5 cm by ultrasonography. Therefore, when removing the remnant and separating the pocket, care should be taken to avoid arterial injury. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Background : Moyamoya disease (MMD) is a chronic progressive disease leading to recurrent stroke due to occlusion of the terminal internal carotid arteries. Surgical revascularization for symptomatic MMD is an effective treatment for preventing further stroke. However, direct revascularization of advanced MMD remains challenging due to small caliber of the recipient vessel and perforators. Methods: We introduce our technique of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass with figures and video to illustrate the procedure. Conclusion: Surgical nuances of STA to MCA anastomosis will help cerebrovascular neurosurgeons to master low-flow bypass for MMD. [ABSTRACT FROM AUTHOR]

Background: Neurocognitive dysfunctions or psychomotor symptoms of Moyamoya disease may improve after direct revascularization to the anterior cerebral artery (ACA). However, long-distance harvest of the frontal branch of the superficial temporal artery (STA) is needed to reach the cortical ACA, frequently resulting in postoperative wound complications. To solve this problem, we devised a novel method (STA lengthening technique). In this study, we compared the STA lengthening technique and the conventional method regarding postoperative wound complications. Methods: Twenty-five patients who underwent STA-ACA direct bypass from December 2016 to October 2021 were retrospectively reviewed, and postoperative wound complications were recorded. Magnetic resonance angiography was performed to evaluate the patency of the bypass to the ACA and postoperative development of collaterals to the skin flap. Results: Thirty-eight hemispheres (new method [n = 12] vs. conventional method [n = 26]) were treated. Wound complications occurred in 12 surgeries (46%) of the conventional method, and none (0%) of the new method. The anastomosis with the cortical ACA was patent in all surgeries. Postoperative development of collaterals to the skin flap was confirmed after all surgeries (100%) in the new method, whereas after only five surgeries (20%) in the conventional method. Conclusion: The STA lengthening technique can enable to preserve the collateral circulation to the skin flap postoperatively, resulting in good wound healing. [ABSTRACT FROM AUTHOR]

Background : Based on portraits of the time, this description provides novel evidence that the celebrated Renaissance artist and genius of human anatomy, Michelangelo Buonarroti (1475–1564), suffered from a vascular disorder known as giant cell arteritis or Horton's disease. Methods: Two portraits and a bronze sculpture produced between 1535 and the second half of the sixteenth century, in which Michelangelo was represented at over 60 years of age, reveal dilation of his superficial temporal artery consistent with that found in patients with Horton's disease or even with chronic arteriosclerosis. In addition, specialized authors indicate Michelangelo showed some of the neurological symptoms of this disease (blindness in old age, depression, and fever). Results: These findings, at least in part, may explain the origin of the neurological debilitations Michelangelo faced in old age and that may even have contributed to his death. Conclusion: This description can serve as an important tool for analyzing his state of health during this period of his life. [ABSTRACT FROM AUTHOR]

Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is usually performed via the subtemporal approach (StA), anterior transpetrosal approach (ApA), or combined petrosal approach (CpA), but no study has yet reported a quantitative comparison of the operative field size provided by each approach, and the optimal approach is unclear. The objective of this study is to establish evidence for selecting the approach by using cadaver heads to measure the three-dimensional distances that represent the operative field size for STA–SCA bypass. Ten sides of 10 cadaver heads were used to perform the four approaches: StA, ApA with and without zygomatic arch osteotomy (ApA-ZO− and ApA-ZO+), and CpA. For each approach, the major-axis length and the minor-axis length at the anastomosis site (La-A and Li-A), the major-axis length and the minor-axis length at the brain surface (La-B and Li-B), the depth from the brain surface to the anastomosis site (Dp), and the operating angles of the major axis and the minor axis (OAa and OAi) were measured. Shallower Dp and wider operating angle were obtained in the order CpA, ApA-ZO+, ApA-ZO−, and StA. In all parameters, ApA-ZO− extended the operative field more than StA. ApA-ZO+ extended La-B and OAa more than ApA-ZO−, whereas it did not contribute to Dp and OAi. CpA significantly decreased Dp, and widened OAa and OAi more than ApA-ZO+. ApA and CpA greatly expanded the operative field compared with StA. These results provide criteria for selecting the optimal approach for STA-SCA bypass in light of an individual surgeon's anastomosis skill level. [ABSTRACT FROM AUTHOR]

Objectives: Cluster headache is a primary headache disorder, which has affected up to 0.1% population. Superficial temporal artery ligation combined with auriculotemporal nerve transection (SLAT) is one of the surgical alternatives to treat the drug-resistant temporal cluster headache (TCH). The current work aimed to assess the effect of SLAT on TCH patients based on the very long-term clinical follow-up. Methods: The current retrospective study had enrolled 20 adolescent TCH patients undergoing SLAT between December 2016 and January 2018. The headache diaries as well as the pain severity questionnaire of the visual analog scale (VAS) had been collected to measure the pain severity before and after surgery. Results: The pain-free rates 3 days, as well as 1, 6, and 12 months, after SLAT surgery were 2.00%, 10.00%, 25.00%, and 70.00%, respectively. The frequency of TCH attack daily was found to be markedly reduced on the whole; besides, the pain degree was also remarkably decreased. Conclusions: Results in this study indicate that the sustained headache can be relieved after SLAT in adolescent patients with intractable TCH. [ABSTRACT FROM AUTHOR]

The effects of superficial temporal artery to middle cerebral artery (STA-MCA) double bypass on recurrent hemorrhage in the operated hemisphere in hemorrhagic moyamoya disease (HMD) have not been clearly demonstrated. This study evaluated the effectiveness of STA-MCA double bypass in the prevention of further hemorrhagic or ischemic events in the operated hemispheric sides in comparison to the conservatively treated non-operated sides. We retrospectively analyzed 52 hemispheres of 36 patients with adult-onset HMD treated with STA-MCA double bypass. Twenty and 16 patients underwent unilateral (unilateral group) and bilateral (bilateral group) surgery, respectively. In addition, the perioperative and long-term outcomes of the 52 operated sides and 20 non-operated sides in the unilateral group were compared. All bypass surgeries were successful, but 21% of the operated sides showed hyperperfusion as estimated by our methods. Perioperative mortality and morbidity rate were 0% and 5.6%, respectively. Concerning long-term follow-up, the annual rebleeding rate (ARR) in the unilateral and bilateral group was 2.7% and 2.6%/person-year, respectively (p = 0.256). The ARR in the operated and non-operated sides was 1.1% and 1.8%/side-year, respectively (p = 0.163). Two of 20 non-operated sides suffered from ischemic infarction during the follow-up period, while none of the 52 operated sides experienced ischemic events (p < 0.05). Although the long-term rebleeding rate in the operated hemisphere tended to be lower after STA-MCA double bypass compared with that in the non-operated hemisphere, the difference was not statistically significant. In conclusion, while STA-MCA double bypass could not clearly prevent rebleeding, it can prevent further ischemic attacks in patients with HMD. [ABSTRACT FROM AUTHOR]

Object: Microsurgical anastomosis from the superficial temporal artery (STA) to the middle cerebral artery (MCA) is a treatment option for appropriately selected patients with cranial atherosclerotic steno-occlusive disease (CASD). However, the long-term efficacy and patency of the donor artery remain unclear. We reviewed the signal intensity of the donor artery on magnetic resonance angiography (MRA) after STA-MCA anastomosis in patients with CASD and clarified the incidence of and risk factors for reduction in postoperative signal of STA. Methods: From April 2007 to March 2015, 155 STA-MCA anastomosis operations for CASD were performed at our institute. The postoperative imaging findings of 112 patients with available follow-up data for more than 3 months were retrospectively reviewed. Results: Over a median follow-up of 24 months, the signal of the donor artery on MRA became weaker than that on MRA performed immediately after surgery in 30 (27%) patients. The rates of signal reduction at 1 and 2 years after surgery were 18 and 25%, respectively. Multivariate analysis revealed that a high STA bifurcation ( p = 0.015; odds ratio, 7.14) and the presence of chronic kidney disease ( p = 0.011; odds ratio, 5.59) were independent risk factors for postoperative signal reduction. Conclusions: Our results suggest that the signal intensity of the donor artery of an established STA-MCA bypass decreases in many cases. Both the loose entrance of the STA to the dura and systemic atherosclerosis are related to postoperative vessel remodeling. [ABSTRACT FROM AUTHOR]

A 14-year-old boy experienced sudden headache in the left parietal region, without any history of head trauma. Approximately 40 ml of hematoma was aspirated using a 22-gauge needle, and scalp swelling immediately disappeared. However, the swelling recurred bilaterally 2 weeks later. Left external carotid angiography revealed a reticular shadow consistent with subgaleal hematoma from a branch of bilateral superficial temporal arteries, without any arteriovenous shunts. The patient was successfully treated using the combination of hematoma aspiration and embolization of the superficial temporal artery. The combination of aspiration of hematoma and embolization may be effective for refractory non-traumatic subgaleal hematoma. [ABSTRACT FROM AUTHOR]

Purpose: This case study demonstrates a new operative method of eyebrow reconstruction, in which the hair density of the reconstructed eyebrow is controlled by the surgeon and is more similar to that of the uninjured side, resulting in a more natural facial expression and greater aesthetic value for our patients. Materials and Methods: The operation was divided into two stages: Stage 1: Implantation of a soft tissue expander into the corresponding subgaleal position of the parietal branch of the superficial temporal artery on the injured side, followed by dilation of the expander until the density of the hair on the expanded scalp reached a suitable value and was lower than that of the uninjured eyebrow. Stage 2: Harvesting of the scalp island flap pedicled by the superficial temporal artery, the end of which was attached to the expanded scalp, followed by the downward movement of the flap to the defect site of the eyebrow via a subcutaneous tunnel, resulting in new eyebrow formation. Results: In eight cases who were monitored for 4-16 months of follow-up, almost all of the reconstructed eyebrows successfully assumed a desirable shape and exhibited a natural appearance, which was consistent with preoperative expectations; the transplanted hairs were highly similar to those of the original eyebrows. All participants remained healthy after the operation, which was indicated by sufficient blood supply to the expanded flap and normal growth of a new eyebrow without postoperative complications. Conclusion: Our study demonstrated the excellent performance of an innovative procedure in which a expanded scalp island flap pedicled by the superficial temporal artery was used in the construction of a new eyebrow. It can be performed very safely and reliably to ensure expected results. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: The validity of indirect bypass for adult patients with moyamoya disease is still debatable. Some patients are poor responders to indirect bypass, and additive intervention is occasionally required in these cases. Therefore, it is necessary to evaluate the development of collateral circulation as early as possible postoperatively. Methods: Fifteen adult patients (>17 years old) with moyamoya disease (22 affected sides) who underwent encephalo-duro-arterio-synangiosis (EDAS) at Fukuoka University Hospital from April 2008 to August 2014 were included. All patients had ischemic symptoms of at least one hemisphere. Superficial temporal artery duplex ultrasonography (STDU) was performed before and 3, 6, and 12 months postoperatively. Digital subtraction angiography was performed 1 year after the operation to evaluate the development of collateral circulation. Hemispheres exhibiting collateral formation of more than one-third of the MCA distribution were defined as good responders, and those with less than one-third were defined as poor responders. Results: EDAS induced the formation of well-developed collaterals in 17 of 22 affected sides (77.3%) of adult patients with ischemic moyamoya disease. Regardless of the degree of collateral formation, the ischemic event subsided eventually with time in all patients. In good responders, the pulsatility index obtained by STDU showed a drastic decrease 3 months after the operation, while it did not change significantly in poor responders. Absence of this decrease in the pulsatility index along with no change in the flow velocity reliably indicated poor responders. Conclusions: Neovascularization after EDAS can be evaluated noninvasively in early phase using STDU. [ABSTRACT FROM AUTHOR]

The histopathological features of the middle cerebral artery (MCA) and superficial temporal artery (STA) from moyamoya disease (MMD) and their relationships with gender, age, angiography stage were explored. The causes and the clinical significance of vasculopathy of STA were also discussed. The clinical data and specimens of MCA and STA from 30 MMD patients were collected. Twelve samples of MCA and STA from non-MMD patients served as control group. Histopathological examination was then performed by measuring the thickness of intima and media, and statistical analysis was conducted. The MCA and STA specimens from MMD group had apparently thicker intima and thinner media than those from the control group. There was no significant pathological difference between the hemorrhage group and non-hemorrhage group, and between the males and females in MMD patients. Neither the age nor the digital subtraction angiography (DSA) stage was correlated with the thickness of intima in MCA and STA. MMD is a systemic vascular disease involving both intracranial and extracranial vessels. Preoperative external carotid arteriography, especially super-selective arteriography of the STA, benefits the selection of donor vessel. [ABSTRACT FROM AUTHOR]

Transverse-sigmoid dural arteriovenous fistulas (TS DAVFs) can be challenging to treat by endovascular means. Indeed, a total cure of the fistula can only be achieved when complete occlusion of the fistulous point(s) is obtained by penetration of the embolic agent. However, in some cases, especially for transosseous branches from extracranial arteries like the occipital artery (OcA) or the superficial temporal artery (STA), such penetration is usually poor, leading to major proximal reflux and incomplete fistula obliteration. We present three cases of embolization in two patients with TS DAVF through the OcA and/or the STA with Onyx® using a double-lumen balloon (Microvention, Tustin, CA, USA). This technique allows the penetration of the embolic agent in the transosseous branches by forming a counter-pressure with the inflated balloon. This technique may be useful to achieve complete occlusion of TS DAVFs by endovascular means. [ABSTRACT FROM AUTHOR]

Long-term patency of superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery for atherosclerotic disease and associated risk factors for loss of patency have rarely been discussed. We retrospectively analyzed long-term patency following STA-MCA bypass and evaluated various demographic and clinical factors to identify the ones predictive of postsurgical loss of patency using records of 84 revascularization procedures (58 patients, 45 males; mean age at surgery 63.6 years, range 31-78 years). Bypass patency was diagnosed based on magnetic resonance angiography or three-dimensional computed tomography. The mean follow-up period was 24.7 months (range 6-63 months). Decreased bypass patency was observed in 4 of 58 patients (6.9 %) who collectively underwent 6 bypasses (7.1 %) of 84. All cases of decreased bypass patency were first detected within 6 months of surgery. Bypass patency was not correlated with age, sex, number of anastomoses, postoperative cerebral infarction, or control of postoperative diabetes mellitus. We found a significant association of bypass patency with hyperperfusion ( p = 0.01) and postoperative smoking ( p = 0.0036). Furthermore, we found a significant association of hyperperfusion with STA diameter ( p < 0.0001), location of anastomosis ( p = 0.075), and preoperative cerebral blood flow ( p = 0.0399). In our retrospective study, hyperperfusion and smoking after surgery may be risk factors for decreased bypass patency in cerebral atherosclerotic disease patients. Careful monitoring of patency to prevent hyperperfusion and cessation of smoking are recommended, particularly within 6 months of the surgery. [ABSTRACT FROM AUTHOR]

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Purpose: This study was performed to investigate any bilateral differences in the vascular pattern and microsurgical relevant parameters of the superficial temporal artery (STA) in vivo. Methods: Digital subtraction angiographies of the STA of 38 individuals were retrospectively analyzed. A bilateral comparison of the branching pattern as well as of surgically relevant diameters and lengths of the main branches of the STA was performed. Moreover, gender-specific differences were assessed. Results: Only 10 cases (26 %) demonstrated an identical type and subtype of the STA pattern bilaterally. The diameters of the STA at its origin and bifurcation level as well as of its parietal branch were statistically significant wider on the right than on the left side ( p = 0.0009, p = 0.006, p = 0.030). Moreover, the diameters of the STA at its origin level on the right side, at its bifurcation level on both sides and of the frontal branch on both sides were statistically significant wider in males than females. No statistically significant differences of the lengths of the STA and its main branches between the right and the left side were identified. Conclusion: The occurrence of the vascular pattern of the STA in vivo is random for each side of the same person and cannot be predicted by the vascular pattern of the opposite side. The calibers of the main branches of the STA are gender specific and commonly larger on the right than on the left side. [ABSTRACT FROM AUTHOR]

The superficial temporal artery (STA) is frequently used as donor vessel in extracranial to intracranial bypass surgery. Current techniques typically rely on a Doppler vascular probe to identify the STA trajectory prior to the skin incision; however, this step can be time consuming and difficult when the arterial course is tortuous. We tested an alternative neuronavigation-based technique for locating the STA. In this method, preoperative magnetic resonance angiography (MRA) or computed tomography angiography (CTA) was used to determine STA outlines that were then projected and traced onto the skin. The neuronavigation-based technique was applied to eight STA dissections. The accuracy of this method was evaluated by comparing the navigation-based STA course with the doppler-based one and the actual STA course intraoperatively. STA trajectory was determined before surgery by using three imaging techniques: CTA (3 cases), three-dimensional (3D) contrast-enhanced T1-weighted MRA (4 cases), and/or 3D time-of-flight MRA (5 cases). In all cases, the neuronavigation-based STA position was confirmed with the Doppler vascular probe before skin incision and corresponded to the actual vessel position intraoperatively. As long as the skin is not mobilized during preoperative image acquisition and surgery, this neuronavigation-based approach is a valid method to identify STA course. During the preoperative planning process, the STA trajectory should be analyzed from its origin at the level of the foramen spinosum to avoid mistaking nearby venous structures as the STA. [ABSTRACT FROM AUTHOR]

Background: The frontal branch of the superficial temporal artery (Fbr) is vulnerable to damage triggered by iatrogenic manipulation by both dermal filler and BoNT-A injection. The purpose of this study was to elucidate the branching pattern of Fbr and to determine its location and course on the lateral border of the frontal belly of the occipitofrontalis muscle (FB). Methods: Sixty-four hemifaces from 38 Korean cadavers (26 males and 12 females; mean age 71.9 years) were dissected, and the location and course of the Fbr were identified with reference to the lateral border of the FB. Results: The ramification of the frontal branch from the superficial temporal artery (STA) occurred 36.9 ± 14.24 mm (mean ± SD) superior and 17.2 ± 8.2 mm anterior to the posterior-most point of the tragus [i.e., tragion (Tg)]. The Fbr was observed as a single branch in 96.9 % of cases and reached its destination at a single point in 71.9 %. It reached the Fbr 14.8 ± 7.7 mm superior to the uppermost point of the eyebrow and 15.8 ± 9.1 mm from the lateral epicanthus. The Fbr bifurcated into superior and inferior branches before reaching the FB in 25.0 % of cases. In two cases (3 %), the Fbr ramified from the STA within 1 mm of the Tg. The diameter of the superior division of Fbr was 1.6 ± 0.5 mm at the lateral border of the FB and 1.8 ± 0.6 mm at other locations. Conclusion: Physicians performing injection treatments such as botulinum toxin type A and dermal filler injection to the posterior frontal area should be aware of the various distributions of the Fbr. [ABSTRACT FROM AUTHOR]

Pseudoaneurysms of the superficial temporal artery (STA) must be considered in the differential diagnosis of masses of the lateral forehead and temporal fossa. Although the first reported case of a temporal artery aneurysm was by Thomas Bartholin in 1740, this lesion receives scant mention in the plastic and maxillofacial surgical literature. A history of recent blunt trauma or surgery to the forehead combined with a pulsatile bruit should direct the physician to this diagnosis. A case of pseudoaneurysm arising from the frontal branch of the left STA 2 months after Botox injection is presented. The patient underwent embolization of the STA with Onnix. A similar case was previously reported once in the world literature. [ABSTRACT FROM AUTHOR]

Background: Aneurysms of the superficial temporal artery (STA) usually are pseudoaneurysms and occur after blunt or penetrating trauma to the head or after surgery in the temporal region. However, true aneurysms of the STA are very rare. This report describes the case of a true aneurysm of the STA that appeared after trauma and discusses several relevant studies about the development and mechanism of this aneurysm. Methods: A 57-year-old woman was referred to the neurosurgery department due to a slowly growing mass on her left parietal scalp. She reported a history of trauma to the head 3 months before the consultation. However, examination showed the scar located far from pulsatile mass. Imaging studies showed a fusiform aneurysmal dilation of the parietal branch of the STA. The frontal branch likely was occluded due to the previous injury. Results: Surgical removal was performed, and the proximal STA was ligated. Histologic examination showed all three layers of the arterial wall to be intact and only luminal dilation. No sign of atherosclerosis or inflammation was detected. Conclusion: The aneurysm in this case was a true aneurysm. The mechanism underlying the spontaneous development of this true aneurysm is not fully understood, although it is possible that insensible minor blunt trauma weakened the arterial wall or reduced the elasticity of the artery. Increased blood flow of the parietal branch due to occlusion of the frontal branch can facilitate aneurysmal dilation. It is speculated that the real incidence of traumatic true STA aneurysms has been underreported. Thus, the authors recommend histologic examination in all traumatic aneurysm cases. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors . [ABSTRACT FROM AUTHOR]

Background: Double superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery has typically involved more than one linear incision. In this report, we demonstrate how the procedure can be performed through a single linear skin incision over the parietal branch of the STA. Methods: Initial dissection of the parietal branch and creation of a subcutaneous cavity along the frontal branch were performed using the conventional microscopic method. Detailed additional dissection and isolation of the frontal branch were accomplished with the aid of an endoscopic retractor. Results: This procedure was performed in five patients for harvesting of approximately 8- and 5-cm lengths of the parietal and frontal branches, respectively. The resultant lengths of the harvested vessels were sufficient for anastomotic revascularization of MCA recipient arteries in both the frontal and temporal lobes. Conclusion: This method can be safely performed with achievement of a less invasive dissection of the STA and an overall improved cosmetic outcome. [ABSTRACT FROM AUTHOR]

Introduction: Pseudoaneurysm arising from the superficial temporal artery (STA) is an uncommon sequela of head and facial trauma. This entity is very rare in the pediatric population. The conventional treatment is surgical excision. Case report: A 13-month-old boy presented with a progressively enlarging subcutaneous mass in the left forehead that appeared 1 week after indoor minor head trauma. The mass was hard and prominently expansile and was more than 5 cm in the largest dimension. The mass did not have audible bruit and was not diminished by manual compression of the proximal STA. Cranial computed tomography (CT) did not reveal intracranial hemorrhage or skull fracture in association with the head trauma. CT angiography showed a large aneurysm arising from the anterior branch of the left STA. Result: En bloc extirpation of the aneurysm was performed. Histological examination of the excised specimen showed findings consistent with pseudoaneurysm. Conclusion: In addition to careful observation for a sufficiently long period after the head trauma, neurosurgeons should be aware of the need to start treatment before a traumatic pseudoaneurysm reaches a significant size. [ABSTRACT FROM AUTHOR]

Repair of scalp defects using local hair bearing scalp is technically challenging. Transposition or rotation of local flaps to close the defect has its own disadvantages. Reconstruction of scalp defect using superficial temporal fascia pedicled V-Y advancement flap using both frontal and parietal branches of superficial temporal artery following the excision of a benign and a malignant pathology is reported here. It is possible to reconstruct the defect with hair bearing scalp in a single stage along with primary closure of the donor site using this technique. [ABSTRACT FROM AUTHOR]

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Pseudoaneurysm of the superficial temporal artery (STA) is usually caused by head or facial injury and is rarely reported in children. It is frequently discovered as a pulsatile cystic mass in the temple, and its diagnosis can be made with ultrasound or computerized tomography angiogram (CTA). Treatment modalities consist of surgical excision and endovascular embolization. A 14-year-old boy presented with a pulsatile, cystic, and painless mass in the left anterior temporal region, developed 6 weeks after head injury from a traffic accident. The mass was 15 mm in diameter and compressible, and disappeared after manual compression of the proximal STA. Bruit was audible over the mass with a stethoscope. CTA showed a pseudoaneurysm of the anterior division of the left STA. The mass was resected with ligation of the proximal and distal ends of the STA. A pseudoaneurysm of the STA should be suspected in a child presented with a pulsatile, cystic mass in the temple, developed after head injury. It can be easily diagnosed with history and physical examination with the aid of imaging modalities such as Doppler ultrasonography and CTA. Pseudoaneurysms are usually successfully treated with excision. [ABSTRACT FROM AUTHOR]

Purpose: To describe the course and configuration of the superficial temporal artery (STA) around the zygomatic arch. Methods: Volume rendered 3D reconstructions of computed tomography angiography of 25 healthy patients were performed and analyzed at Duke University Hospitals. Results: The STA coursed over the zygomatic arch or over the condylar process of the mandible in all cases (25/25 pts, 100 %). The STA courses over the posterior zygomatic arch in 23/25 pts (92 %), creating a characteristic 'C' shape half-buttonhole configuration as it embraces the arch. When the STA travels posterior to the zygomatic arch, there is no C shape configuration (2/25 pts, 8 %). The STA bifurcates distal to the zygomatic arch in 24/25 pts (96 %). Conclusions: The 'C' shape half-buttonhole configuration is a useful identifying characteristic of the most common course of the STA-over the posterior zygomatic arch before it bifurcates. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the use of a radial artery graft (RAG) for bypass of the proximal superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) by posterior oblique transzygomatic subtemporal approach as an alternative to the external carotid artery (ECA) to PCA anastomosis. We conducted an anatomical and technical study at a university hospital. Five adult cadaveric specimens were dissected. A preauricular vertical skin incision was used. The trunk of STA was identified. A 30° oblique posterior zygomatic arch osteotomy and microcraniotomy was performed. The dura of the middle cranial fossa was then opened. The temporal lobe was retracted, the interpeduncular and ambient cisterns were opened, and the P2 segment of the PCA was exposed. The proximal side of the RAG was anastomosed with the proximal STA and the distal side was anastomosed with the P2 segment. The mean caliber of the proximal STA was 2.25 ± 0.35 mm. The mean diameter of the P2 was 2.2 ± 0.2 mm. The average length of the RAG was 56 ± 3.2 mm. The mean caliber of the proximal and the distal sides of the graft was 2.5 ± 0.25 mm and 2.3 ± 0.15 mm, respectively. Because the proximal STA to proximal PCA bypass uses a short RAG and their calibers are over 2 mm, this bypass technique can provide a sufficient blood flow and may be a reasonable alternative over ECA to PCA bypass using long grafts. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the efficacy of intra-arterial infusion chemotherapy for head and neck cancers using a coaxial catheter technique: the superficial temporal artery (STA)–coaxial catheter method. Thirty-one patients (21 males and 10 females; 37–83 years of age) with squamous cell carcinoma of the head and neck (maxilla, 2; epipharynx, 4; mesopharynx, 8; oral floor, 4; tongue, 10; lower gingiva, 1; buccal mucosa, 2) were treated by intra-arterial infusion chemotherapy. Four patients were excluded from the tumor-response evaluation because of a previous operation or impossibility of treatment due to catheter trouble. Forty-eight sessions of catheterization were performed. A guiding catheter was inserted into the STA and a microcatheter was advanced into the tumor-feeding artery via the guiding catheter under angiographic guidance. When the location of the tumor or its feeding artery was uncertain on angiography, computed tomographic angiography was performed. The anticancer agent carboplatin (CBDCA) was continuously injected for 24 h through the microcatheter from a portable infusion pump attached to the patient’s waist. The total administration dose was 300–1300 mg per body. External radiotherapy was administered during intra-arterial chemotherapy at a total dose of 21–70.5 Gy. The initial response was complete response in 15 patients, partial response in 7 patients, and no change in 5 patients; the overall response rate was 81.5% (22/27). Complication-related catheter maintenance was observed in 15 of 48 sessions of catheterization. Injury and dislocation of the microcatheter occurred 10 times in 7 patients. Catheter infection was observed three times in each of two patients, and catheter occlusion and vasculitis occurred in two patients. Intra-arterial infusion chemotherapy via the STA–coaxial catheter method could have potential as a favorable treatment for head and neck tumors. [ABSTRACT FROM AUTHOR]

True superficial temporal artery aneurysms are rare, while pseudo-aneurysms are more common. We report the case of a 43-year-old gentleman who had a pulsatile swelling in the right pre-auricular region with no history of trauma. He underwent an uneventful and curative surgical excision of the aneurysm. [ABSTRACT FROM AUTHOR]

The temporoparietal, parieto-occipital flaps or the forehead flaps that are used in reconstructive surgery are prepared on the superficial temporal artery (STA) and its branches. For a successful surgery and a suitable flap design, adequate anatomical knowledge is needed. In our study, the red colored latex solution was injected into the external carotid artery; the STA and its branches were dissected in 27 specimens. The mean diameter of the STA at the zygomatic arch was determined as 2.73±0.51 mm. The diameters of the frontal branch were bigger than those of the parietal branch in 15 samples out of 27. The diameters of both the frontal and parietal branches were equal in four samples. The diameter of the parietal branch was bigger than that of the frontal branch in eight samples. In 20 samples out of 27 (74.07%), the bifurcation point of the STA was above the arch. In six samples (22.22%), the STA bifurcated directly over the arch. In only one sample (3.70%), bifurcation was not observed and the STA continued only as a frontal branch (absence of the parietal branch). The absence of the frontal branch was not encountered. In one sample (3.70%), double parietal branches were observed. In six samples out of 27 (22.22%), zygomatico-orbital artery was not encountered. In 21 samples (77.77%), zygomatico-orbital arteries ran towards the face, parallel to zygomatic arch and distributed in the orbicularis oculi muscle. The transverse facial artery existed in all samples. The auricular branches running to the helix and tragus were observed in all samples. The STA was 16.68±0.35 mm at the front of the tragus. Some landmarks were chosen on the head and then the STA was observed where it crossed all of these landmarks. This paper confirms the well-known variability of the superficial temporal arterial branches and their relation to the pericranial region. Knowledge concerning the arterial features of the lateral forehead region is important for the aesthetic surgeon. STA and its branches have been found to be suitable for use in microvascular anastomoses. A better understanding of the midline forehead vascularity should allow modification of reconstructive techniques and reduce postoperative complications. [ABSTRACT FROM AUTHOR]

We present the use of radial artery graft for bypass of the proximal superficial temporal artery to the proximal middle cerebral artery. Six adult cadaver sites were used bilaterally. After apterional incision, 2×2-cm minicraniectomy was performed which began 2 cm behind the zygomatic process of the frontal bone. The superficial temporal artery was transsected before exposing the zygomatico-orbital artery branch. The proximal side of the radial artery graft was anastomosed end-to-end to the proximal superficial temporal artery and the distal side end-to-side to the proximal middle cerebral artery. The mean calibers of the proximal superficial temporal artery and largest trunk of the middle cerebral artery were 2.25±0.35 mm and 2.3±0.3 mm, respectively. The average graft length was 85±5.5 mm. We conclude that such bypasses are simpler than proximal middle cerebral artery revascularization using long vein grafts. This method proves that the caliber of the proximal superficial temporal artery is more suited to providing sufficient flow than the distal superficial temporal artery, and the graft is short. Such bypasses to the middle cerebral artery may be an alternative to those from the distal superficial temporal artery or extracranial carotid artery. [ABSTRACT FROM AUTHOR]

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An elderly patient suffering from the posttraumatic development of a superficial temporal artery (STA) aneurysm is described. Because the patient had renal dysfunction, angiography was performed through a direct puncture of the anterior branch of the STA in order to reduce the required dosage of contrast medium. With the patient under local anesthesia, the STA was ligated proximal and distal to the aneurysm, and thereafter removed. The diagnosis and treatment of traumatic STA aneurysms in the elderly are discussed. [ABSTRACT FROM AUTHOR]

A portable instrument, based on a volume-compensation technique, is designed for ambulatory monitoring of indirect beat-to-beat blood pressure (BP) in the superficial temporal artery. The instrument consists of a small disc-type cuff and a portable unit carried by the subject. Several components are integrated in the cuff for applying counter-pressure to the artery, i.e. a reflectance-type photo-plethysmographic sensor for arterial volume detection, a pressure sensor for cuff pressure Pc measurement and a nozzle flapper-type- electro-pneumatic convertor for controlling Pc. The portable unit includes volume servo control circuitry and a microprocessor-based signal-processing and recording unit. This automatically performs all the necessary measurement procedures and stores into a memory IC element the processed systolic, mean and diastolic blood pressure data, together with pulse intervals on a beat-to-beat basis from the servo-controlled Pc (indirectly measured BP waveform). With this instrument, momentary changes in BP during ambulatory situations such as bicycle ergometer exercise and daily activities including motorway driving are successfully recorded. From the results of simultaneous measurement of the subject's posture changes, the effect of posture change on blood pressure, e.g. baroreceptor-cardiac reflex, is also clearly demonstrated. [ABSTRACT FROM AUTHOR]

Rest segments of superficial temporal arteries obtained during STA-MCA anastomoses were studied histologically and histometrically. Aging was found to be associated with thickening of the intimal layer and thinning of the medial layer. In comparison with the young patients, the old patients showed a larger internal diameter of the superficial temporal artery and a larger ratio of the thickness of the intimal layer to the medial layer. The internal diameter calculated angiographically and the internal diameter estimated histologically correlated well. The dilatation ratio of the superficial temporal artery did not correlate with dimensional data assessed histologically. [ABSTRACT FROM AUTHOR]

An anatomical study was undertaken on 15 fresh cadavers to evaluate the midline anastomoses between the two superficial temporal arteries (STA), especially at the level of the galea and the superficial temporal fascia. Arteriography of the STA and microscopic sections along the midline of the scalp at 3 cm on both sides demonstrated the constant presence of anastomoses between the two STA. However, the anastomoses were constantly more superficial in the frontal area, whereas they were closer to the galea in the parietal territory. A safe dissection of the galea at this level can, therefore, be extended to the opposite side without damaging its blood supply and the hair follicles of the vertex. It does not seem possible to perform this in the frontal area. [ABSTRACT FROM AUTHOR]

We describe secure surgical method for catheter placement using ultrasonic scalpel via the occipital artery to achieve retrograde superselective intra-arterial chemotherapy for advanced oral cancer, as alternative to approach via the superficial temporal artery. [ABSTRACT FROM AUTHOR]

Possible complications of parotid gland surgery are numerous, just as the reasons for aneurysms of the superficial temporal artery. The occurrence of such an aneurysm as a consequence of parotidectomy, however, has so far only been published once. Here, we report of an aneurysm of the superficial temporal artery following parotid gland surgery. It presented as a pulsating mass in the preauricular region. Combining clinical examination, duplex ultrasound, and CT scan, the diagnosis was readily established and treated with a circumscribed revision at low risk and without complications. [ABSTRACT FROM AUTHOR]

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The temporal artery courses superficially over the temporal bone and thus can be vulnerable to trauma. Although traumatic lacerations of this vessel are indeed common, trauma-induced arteriovenous fistulae involving the temporal artery are relatively rare. Arteriovenous fistulae caused by iatrogenic injury to the temporal artery are rarer still. We report a case of an ateriovenous fistula involving the superficial temporal artery which developed after surgical repair of trauma to the vessel following a blunt head injury. Ultimately, the lesion was successfully treated with complete excision. [ABSTRACT FROM AUTHOR]

Robotic-assisted surgery is becoming more prevalent and accepted in the USA and is routine in many medical centers across a variety of specialties, but mainly in urology and general surgery. However, neurosurgery has yet to embrace this new technology. We used the da Vinci® robot (Intuitive Surgical, Sunnyvale, California) to perform a robotic-assisted superficial temporal artery-to-middle cerebral artery bypass on a cadaveric head. The object of this technical note is to describe the use of the da Vinci® robot to perform an extracranial–intracranial bypass. Using a cadaveric human head, the da Vinci® robot was successfully used to anastomose the superficial temporal artery to an M2 branch of the middle cerebral artery. We were successfully able to demonstrate the utility of using the da Vinci® robot in extracranial to intracranial anastomosis in a cadaveric head. The optics were excellent and physiologic tremor was eliminated. More studies are needed to assess the feasibility, safety, and utility of this device in living tissue within the field of neurosurgery. [ABSTRACT FROM AUTHOR]

Pseudoaneurysm of the superficial temporal artery is rare in children and is frequently a result of direct facial trauma. Conventional management has included surgical ligation and resection and more recently endovascular embolization to prevent complications including local pain, headache, facial disfigurement and bleeding. We report a unique case of a US-guided percutaneous thrombin injection for the treatment of a post-traumatic superficial temporal artery pseudoaneurysm in a child. [ABSTRACT FROM AUTHOR]

A case of traumatic pseudo-aneurysm of the superficial temporal artery documented on Computed tomography (CT) and angiography is described in a 55-years-old female, who was treated by surgical excision. Computed tomographic appearance of this lesion is illustrated. This represents, to our knowledge, the first CT demonstration of traumatic aneurysm of superficial temporal artery within a large subgaleal haematoma. [ABSTRACT FROM AUTHOR]