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Surgery is the mainstay of stroke prevention in patients with symptomatic moyamoya disease (MMD). We present the results of a single-center retrospective study of indirect revascularization surgery for adult MMD, emphasizing angiographic outcomes, including dilation of the superficial temporal artery and formation of new collaterals. A prospectively maintained database of procedures performed for MMD was reviewed. Adult patients treated with indirect revascularization and with long-term angiographic follow-up were included. Preoperative and postoperative angiographic images and baseline and procedural characteristics were analyzed. A Wilcoxon signed-rank test was used to test the hypothesis that the superficial temporal artery increases in diameter postoperatively. We identified 40 hemispheres in 27 patients, of which 35 had a sufficient angiographic follow-up. Bilateral procedures were performed on 16 patients. Most patients were female (72.5%), with a median age of 43 years old. The most common clinical presentation was ischemic stroke in 59.3% of cases. All patients underwent an encephaloduroarteriosynangiosis for treatment. A follow-up angiogram was performed at a median of 13.8 months postoperatively, showing superficial temporal artery (STA)-derived collaterals in 71.4% and collateral ingrowth via the burr holes in 61.8% of cases. Disease progression was evident in 34.3% of hemispheres. The normalized STA diameter was significantly increased postoperatively (2.4 to 3 mm; P < 0.05). A univariate analysis revealed that transdural collaterals and hyperlipidemia may affect collateral ingrowth from the STA, and no other patient- or procedure-related factors, including replacement of the bone flap, impacted on this. A significant increase in STA diameter on follow-up angiography after encephaloduroarteriosynangiosis was found; however, this was not directly associated with STA collateral development. Rates of postoperative transient ischemic attacks were low, and no patients had a new ischemic or hemorrhagic stroke at last follow-up. The presence of transdural collaterals and the absence of hyperlipidemia were associated with STA collateral development on follow-up angiography, but the causality of this finding is unclear. [ABSTRACT FROM AUTHOR]

A 77-year-old woman presented to our hospital with a 2-week history of fever, headache, and induration along the bilateral superficial temporal arteries (STAs). The color Doppler ultrasonography of the STA showed a hypoechoic mural thickening surrounding a residual color flow. A contrast-enhanced photon-counting detector (PCD) CT demonstrated mural thickening and stenosis of the bilateral STAs. The patient underwent a biopsy of the right STA. Histopathological findings were consistent with giant cell arteritis (GCA). The patient's symptoms were temporarily relieved after initiation of steroid treatment, but jaw claudication occurred 2 months later. Contrast-enhanced CT showed improved vascular abnormalities of the STAs but new mural thickening and stenosis of the bilateral maxillary artery. Due to its higher resolution, image contrast, and lower noise, PCD-CT may have great potential in detecting, diagnosing, and monitoring GCA.

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]

Tessier number 10 cleft is one of the rarest facial clefts. Surgical treatment of this type of cleft is challenging due to the complexity of periorbital and temporal soft tissue deformities. A 23-year-old male patient presented with typical facial deformities of Tessier number 10 cleft. The surgical procedure involved using a free anterolateral thigh flap to reconstruct the eye socket, while the superficial temporal artery pedicle scalp flap was used to reconstruct the eyebrow deformity. The patient had no complications and 16 months after surgery, the patient had good aesthetic results. A hair-bearing scalp flap with a pedicle of the frontal branch of the superficial temporal artery combined with an anterolateral thigh-free flap can effectively resolve most soft tissue deformities of Tessier number 10 cleft and reconstruct the orbital socket in a single surgery. At the same time, it augments the soft tissue of the frontotemporal area and provides good aesthetic results. [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]

Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery has been widely adopted in treating moyamoya disease (MMD). Geometric variations including high tortuosity and stenosis exist in many cases, but the hemodynamic effects have not been comprehensively evaluated. We aim to evaluate the hemodynamic effects of bypass geometry variations based on patient-specific data. In total, 17 patients with MMD who underwent STA-MCA bypass surgery with highly tortuous bypass geometry were included. For each patient, the original 3-dimensional structure of STA-MCA bypass was reconstructed from clinical imaging data. The bypass structure was virtually improved by removing the tortuosity and stenosis. Computational fluid dynamics simulation was performed on both bypass structures under identical patient-specific condition. The simulated hemodynamic parameters of the bypass and its distal branches were compared between the original and virtually improved bypass geometries in all cases using paired t -test or Wilcoxon signed-rank test. The changes of hemodynamic parameters were compared between the cases with and without mild-to-moderate stenosis (44.0–70.3% in diameter) in the bypass using t -test or Mann-Whitney U test. The virtual improvement of bypass geometry significantly increased the flow rate of the bypass and its distal branches (P < 0.05) and decreased the transcranial flow resistance (P < 0.05). The hemodynamic changes in cases with stenosis removal were significantly greater than those without stenosis (P < 0.05). High tortuosity and stenosis can significantly change the hemodynamics of STA-MCA bypass, and the optimization of bypass geometry deserves further consideration. [ABSTRACT FROM AUTHOR]

Summary: Background: The anatomical parameters of the superficial temporal artery branches were measured by a three-dimensional measurement method to provide anatomical reference for relevant clinical operations. Methods: Seventy original images were selected who had cranial CTA examination. The patients were aged 30–79 years, with an average of 60.0 years, including 32 females and 38 males. After reconstructing the superficial temporal artery by professional medical 3D reconstruction software, its anatomical parameters were measured. Results: The length of the secondary branches of the frontal branch of the superficial temporal artery were 47.6 ± 23.6 mm and 37.3 ± 21.6 mm in males and females, respectively, with a statistically significant difference. The length of the secondary branches of the parietal branch of the superficial temporal artery were 39.6 ± 20.4 mm and 49.2 ± 20.3 mm in young and middle-aged people and older people respectively, which were statistically different. The remaining measures were not statistically different across gender and age groups. The frontal branch of the superficial temporal artery was divided into three types, and the parietal branch of the superficial temporal artery was divided into two types. Conclusions: The anatomical parameters of the superficial temporal artery branches can be accurately measured by means of 3D visualization, providing an anatomical reference for relevant clinical operations.

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]

(1) Background Cerebral revascularization is necessary to treat intracranial arterial stenosis caused by moyamoya disease, atherosclerosis, or large complex aneurysms. Although various donor vascular harvesting methods have been reported safe, there are no reports on the histological evaluation of donor vessels for each disease, despite the variety of diseases wherein vascular anastomosis is required. (2) Methods Pathological findings of the superficial temporal artery (STA), radial artery (RA), occipital artery (OA), and saphenous vein (SV) harvested at the institution were analyzed. Patients classified according to aneurysm, atherosclerosis, and moyamoya disease were assessed for pathological abnormalities, medical history, age, sex, smoking, and postoperative anastomosis patency. (3) Results There were 38 cases of atherosclerosis, 15 cases of moyamoya disease, and 30 cases of aneurysm in 98 donor vessels (mean age 57.2) taken after 2006. Of the 84 STA, 11 RA, 2 OA, and 1 SV arteries that were harvested, 71.4% had atherosclerosis, 11.2% had dissection, and 10.2% had inflammation. There was no significant difference in the proportion of pathological findings according to the disease. A history of hypertension is associated with atherosclerosis in donor vessels. (4) Conclusions This is the first study to histologically evaluate the pathological findings of donor vessels according to disease. The proportion of dissection findings indicative of vascular damage due to surgical manipulation was not statistically different between the different conditions. [ABSTRACT FROM AUTHOR]

Background: The concavity of the temple due to adipose tissue atrophy from aging accentuates the zygomatic arch and lateral orbital rim, leading to an aged appearance. The use of hyaluronic acid filler in the temporal region has gained popularity due to its procedural simplicity and consistent outcomes. Objective: To evaluate the safety of administering hyaluronic acid filler in the temporal region concerning the frontal branch of the superficial temporal artery, which is at risk of injury. Methods: Empirical observations were conducted on the internal diameter of the frontal branch of the superficial temporal artery, a critical anatomical site for potential injury. Results: A significant proportion of the artery segments exhibited an internal diameter below 1 mm. Given that the outer diameter of an 18‐gauge cannula is 1.27 mm, this method can be considered a relatively secure approach for enhancing the temporal region. Conclusion: The use of an 18‐gauge cannula for hyaluronic acid filler administration in the temporal region appears to be a safe and effective method, with the potential risk to the frontal branch of the superficial temporal artery being minimal. [ABSTRACT FROM AUTHOR]

The anatomical parameters of the superficial temporal artery branches were measured by a three-dimensional measurement method to provide anatomical reference for relevant clinical operations. Seventy original images were selected who had cranial CTA examination. The patients were aged 30–79 years, with an average of 60.0 years, including 32 females and 38 males. After reconstructing the superficial temporal artery by professional medical 3D reconstruction software, its anatomical parameters were measured. The length of the secondary branches of the frontal branch of the superficial temporal artery were 47.6 ± 23.6 mm and 37.3 ± 21.6 mm in males and females, respectively, with a statistically significant difference. The length of the secondary branches of the parietal branch of the superficial temporal artery were 39.6 ± 20.4 mm and 49.2 ± 20.3 mm in young and middle-aged people and older people respectively, which were statistically different. The remaining measures were not statistically different across gender and age groups. The frontal branch of the superficial temporal artery was divided into three types, and the parietal branch of the superficial temporal artery was divided into two types. The anatomical parameters of the superficial temporal artery branches can be accurately measured by means of 3D visualization, providing an anatomical reference for relevant clinical operations. • The construction of a three-dimensional visualization model of superficial arteries and branches was completed. • The anatomical parameters of the main branch vessels of the superficial temporal artery and its secondary branch vessels are accurately measured by 3D reconst ruction techniques. • Firstly, the three-dimensional reconstruction technology was used to design and transplant the branch petals with the secondary vascular branches of the superficial temporal artery without damaging the main branch of the superficial temporal artery. [ABSTRACT FROM AUTHOR]

Objective To describe the anatomy related to a novel approach to the petroclival region through the mandibular fossa for the treatment of petroclival and anterior pontine lesions. Design Five dry skulls were examined for surgical approach. Three adult cadaveric heads underwent bilateral dissection. One cadaveric head was evaluated with computed tomography after dissection. Setting This study was performed in an academic medical center. Participants Neurosurgical anatomy researchers performed this study using dry skulls and cadaveric heads. Main Outcome Measurements This was a proof-of-concept anatomical study. Results The mandibular fossa approach uses a vertical preauricular incision above the facial nerve branches. Removal of the temporomandibular joint exposes the mandibular fossa. The anterior boundary is the mandibular nerve at the foramen ovale, and the posterior boundary is the jugular foramen. The chorda tympani, eustachian tube, and tensor tympani muscle are sectioned. The carotid artery is transposed out of the petrous canal, and a petrosectomy is performed from Meckel's cave to the foramen magnum and anterior occipital condyle. Dural opening exposes the anterior pons, vertebrobasilar junction, bilateral vertebral arteries, and the ipsilateral anterior and posterior inferior cerebellar arteries. At completion, the temporomandibular joint is reconstructed with a prosthetic joint utilizing a second incision along the mandible. Conclusions The mandibular fossa approach is a new trajectory to the petroclival region and the anterior pons. It combines the more anterior angle of endoscopic approaches along with the enhanced control of open approaches. Further study is necessary before this approach is used clinically. [ABSTRACT FROM AUTHOR]

Introduction: Thread lifting is a non‐surgical cosmetic procedure that utilizes threads to lift and tighten sagging skin on the face. In Lateral face lifting with anchoring technique, the threads are inserted into the skin and anchored in place to provide support to the skin at artery free zone. This technique utilizes a long cog thread, allowing for stronger fixation points. The optimal location for thread anchoring is in the fascia of the treatment area. Method and materials: The study was performed with twelve cadavers with twenty‐four specimens of head from cadavers and was processed using phosphotungstic acid‐based contrast enhancement micro‐computed tomography and conventional computed tomography. The superficial temporal artery with branches of parietal and temporal were then observed with image Slicer program to analyze the safe anchoring place for the deep temporal fascia. The main branch was selected with diameter over 0.3 mm and less than 0.3 mm was regarded as arteriole. Additionally, a case of deep temporal tagging with the Secret Miracle (Hyundae Meditech Co., Ltd., South Korea) has been used for lifting procedures. Result: The main branch of the parietal branch located posteriorly was located mean of ‐13 mm (range of +5.5 mm to ‐23 mm). And the temporal artery ran most anteriorly had mean of 44 mm anteriorly (range of 32 to 59 mm). The safe area for the tagging is at the deep temporal fascia between the superior temporal line and inferior temporal line. The safe range of deep temporal fascia is a vertical line crossing tragus from 1 to 3 cm anteriorly. Conclusion: By analyzing the result of the superficial temporal artery of parietal and temporal branches the ideal tagging place for the thread anchoring area has been suggested. [ABSTRACT FROM AUTHOR]

The superficial temporal artery (STA) is one of the most encountered vessels in neurosurgery and has a significant importance in cerebral bypass surgery. In cerebral bypass surgery, a suitable donor vessel to create the bypass graft close to the recipient artery with suitable size, is essential. The STA can be harvested easily and is readily accessible, minimizing surgical complexity. Using the STA as the donor artery has shown to have lower rates of complications compared to other graft options. It has a low risk of spasm and thrombosis, which could lead to graft failure. Additionally, harvesting the STA does not cause significant damage to surrounding tissues, reducing the risk of postoperative complications. The STA has a robust and consistent blood flow, making it an ideal candidate for grafting during cerebral bypass surgery. Understanding the variations of the STA is important to surgeons who encounter it during an operation. In this cadaveric study, we obtained length and internal elastic lamina diameter measurements of the STA trunk and its branches. Our cadaveric internal elastic lamina diameters were consistent with the literature's as well as the STA trunk and frontal branch lengths but the parietal branch length measurements were significantly different from the related literature's. Further cadaveric studies of the STA must be conducted as a better understanding the anatomy of this vessel by cerebrovascular surgeons. [ABSTRACT FROM AUTHOR]

Background: Neurofibromatosis type 1 (NF-1) is often characterized by vascular disorders related to vessel vulnerability that can lead to unfavorable outcomes. Here, we describe a case of NF-1 complicated with a massive subcutaneous hematoma posing a risk of visual impairment for which rapid decompression and a subsequent less invasive approach result in a favorable outcome. Case Description: A 40-year-old woman with NF-1 presented with a massive left subcutaneous temporal hematoma following a mild head contusion. Four days after hospitalization, the hematoma increased in size and severely compressed the left eye, prompting immediate hematoma removal to preserve visual function. Immediately after the hematoma removal, a superficial temporal arteriovenous fistula was found on the digital subtraction angiography and embolized by the endovascular procedure. Her visual acuity was preserved, and no bleeding recurrence was observed throughout the follow-up. Conclusion: Surgical hematoma removal followed by endovascular treatment was effective in preserving visual function. Since vessel fragility is characteristic of patients with NF-1, it should be kept in mind that vascular complications may lead to serious clinical outcomes. In certain NF-1 cases, less invasive treatments for vascular abnormalities may be preferable. [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]

Scalp cirsoid aneurysm is an arteriovenous fistula of the scalp that is usually unconnected by intracranial or cerebral vessels. Variceal dilatation of draining veins can produce cosmetic concerns, masses, local pain, palpable thrills, audible bruits, headache, tinnitus, and torrential hemorrhage. Its etiopathogenesis is not well understood. Treatment includes surgery (fistula repair by simple surgical ligation until gross total resection), embolization (whether percutaneous or endovascular), or a combination of the two. Here is a case report of a 40-year-old male patient who had right superficial temporal artery cirsoid aneurysm who underwent surgical ligation with complete excision of the lesion.

Objective To observe the effect of using a pre-auricular flap with vessels to repair the secondary nasal defects after the treatment of nasal tumors. Methods A reversed pre-auricular flap had been performed on six patients with the secondary nasal defects from the tumor removal including five patients with alar defects and one patient with the nasal tip defect. The size of the flap ranged from 3.0 cm×2.5 cm to 6.0 cm×2.5 cm. The reversed superficial temporal vessels of the flap were anastomosed with the recipient facial vessels. Results All the flaps survived uneventfully in the six patients and satisfactory results were achieved during the follow-up. The donor-site defect was minimal after the primary closure. Conclusion The free pre-auricular flap delivers a good solution to the problem of the secondary nasal defects arising from the tumor surgery in the nose. [ABSTRACT FROM AUTHOR]

Plastic surgeons face unique challenges in reconstructing eyebrows due to their complex anatomy and gender variations. We report a case of a 16-year-old female who presented with post-burn bilateral eyebrow alopecia. Bilateral eyebrow reconstruction was performed with scalp island flaps based on the posterior branch of the superficial temporal artery, which showed good postoperative outcomes. This case showed that the superficial temporal artery island flap continues to be a versatile option for managing eyebrow alopecia, especially in cases of deep burns of the face. [ABSTRACT FROM AUTHOR]

This report presents iatrogenic arteriovenous fistula of superficial temporal vessels after thread brow lift, which emphasizes on consideration of such rare complications during the procedure. A young woman presented with pulsatile mass of scalp after tread brow lift. Color Doppler and duplex sonography of the mass revealed an AVF (arteriovenous fistula) of superficial temporal vessels, a complication that in a few articles has been mentioned. Patient had received conservative treatment and the mass became very small and about to be disappeared. physicians must be aware of possible vascular injury during thread face lift and should be trained enough to avoid it.

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]

Scalp cirsoid aneurysm is an arteriovenous fistula of the scalp that is usually unconnected by intracranial or cerebral vessels. Variceal dilatation of draining veins can produce cosmetic concerns, masses, local pain, palpable thrills, audible bruits, headache, tinnitus, and torrential hemorrhage. Its etiopathogenesis is not well understood. Treatment includes surgery (fistula repair by simple surgical ligation until gross total resection), embolization (whether percutaneous or endovascular), or a combination of the two. Here is a case report of a 40-year-old male patient who had right superficial temporal artery cirsoid aneurysm who underwent surgical ligation with complete excision of the lesion. [ABSTRACT FROM AUTHOR]

Harvesting the superficial temporal artery (STA) is the first difficult step in extracranial-intracranial bypass surgery. There are various methods and instruments for harvesting the STA. We used the Lone Star (LS) retractor system for harvesting the STA. The LS retractor system is used in other surgical specialties. The LS retractor system consists of the retractor ring (14.1 cm × 14.1 cm) and elastic stays (5-mm sharp hook). The retractor ring can be used to adjust to the operative field. Retracting the loose connective tissue around the STA by the elastic stays can make harvesting the STA easy and safe. After harvesting the STA, retracting the skin and muscle by the elastic stays is useful for hemostasis during intracranial surgery and anastomosis. We used the LS retractor system in 26 consecutive patients to perform STA-MCA anastomosis between November 2015 and August 2018. All STAs were harvested without complications or injuries. The LS retractor system is a safe and useful method for harvesting the STA. [ABSTRACT FROM AUTHOR]

Summary. Patients with scalp defects require a comprehensive examination to save lives and reduce the consequences of trauma. Plastic surgeons must take into account the anatomical, functional and cosmetic characteristics of the scalp. The aim of the study – to find out the topographical and anatomical relationships of the superficial temporal artery and its branches in human fetuses of 4–8 months. Materials and Methods. The research was carried out on the preparations of 22 human fetuses of 81.0–310.0 mm parietal-coccygeal length (PCL) without external signs of anatomical deviations or anomalies of the development of bone, fascial-muscular and vascular-nervous structures of the head using macromicroscopic dissection, injection of vessels and morphometry. Results. The classic variant of the topography of the superficial temporal artery was found in most of the examined fetuses. In some of them, variants of branching of the superficial temporal artery, variability of the number of branches, and various anastomoses have been established. A variant of branching of the left superficial temporal artery was observed in a human fetus with a 195.0 mm PCL. An anastomosis between the right and left supraorbital arteries and the frontal branches of the right and left superficial temporal arteries was found in a 230.0 mm PCL fetus. In a human fetus with a 180.0 mm PCL, a blood supply variant of the left posterolateral part of the head was found. The left occipital artery provided blood supply not only to the occipital but also to the parietal areas. In another human fetus with a 170.0 mm PCL, a doubling of the right occipital artery was detected. Conclusions. In the fetal period of human ontogenesis, the anatomical variability of the arteries supplying blood to the skin and surface structures of the head has been established. Variants of the topography of the superficial temporal artery, the supraorbital artery, and the occipital artery were revealed, manifested by the variability of the shape, the number of branches, and the formation of arterial anastomoses. The various topographic variants of the branches of the superficial temporal artery, supraorbital and occipital arteries described in human fetuses will help plastic surgeons to choose individually the most rational method of surgical intervention to repair head defects

Background: Superficial temporal artery (STA) aneurysms are very rare compared to vascular aneurysms of other regions. They are divided into two as true and pseudo. Pseudoaneurysm were much more common and often depend on an etiological factor but spontaneous true aneurysms are extremely uncommon and the etiologic causes are not clear yet. Case presentation: We present a 91-year-old female patient who consulted to us with swelling in front of the ear; there was no history of previous surgery or any trauma. The patient had a pulsatile mass in the preauricular region, which started 4 years ago and growed faster for the last 2 months. Conclusion: There was a mass consistent with a saccular type aneurysm whose continuity was observed with the temporal artery in imaging studies. The mass was excised under general anesthesia. The patient whose pathological examination was a true STA aneurysm was discussed in the light of the literature.

Segmental arterial mediolysis (SAM) is a rare non-arteriosclerotic and non-inflammatory vascular disease. Superficial temporal artery (STA) aneurysms are usually associated with trauma, surgery, and hair transplantation. Spontaneous aneurysms of the STA are uncommon, but an STA aneurysm caused by SAM is rare. We report a 70-year-old woman with a spontaneous aneurysm of the STA. The mass in the left parietal region was pulsatile and gradually enlarged in size without any history of head trauma. The mass was successfully removed by surgery and was proved histopathologically to be a true aneurysm with SAM. [ABSTRACT FROM AUTHOR]

Objective To obtain the anatomical topography of superficial temporal artery and middle temporal vein in temporal region through the three-dimensional image. Methods The image data of cranial CTA of patients from January to July 2022 were retrospectively analyzed. A total of 28 patients (14 males and 14 females) were enrolled in this research. The raw data were transferred to the computer and imported into 3D-Slicer software system to reconstruct 56 frontal branch of superficial temporal arteries (STA-Fbr) and middle temporal veins (MTV). The location of vascular bifurcation points, distance from vessels to osseous landmarks, depth of vessels to the skin surface, internal diameter and variation types of blood vessels were measured and evaluated. Results The occurrence rate of STA-Fbr was 100%, whereas that of superficial temporal artery-parietal branch (STA-Pbr) was 91.7% (51/56). The bifurcation point of 96.1% (49/51) STA was located at (32.3±8.2) mm above the zygomatic arch. The inner diameter of frontal branch at bifurcation point was (2.2±0.5) mm, and the average depth to skin surface was (3.7±1.1) mm. The occurrence rate of MTV was 100%. The horizontal segment of its main trunk was (25.6±3.7) mm to the superior margin of the zygomatic arch, the mean diameter of the largest part was (3.3±0.9) mm and the mean depth of vessels to the skin surface was (7.8±1.9) mm. According to the anatomical distribution of these two vessels, the risk zone and low risk zone of injection and filling could be designed. Conclusion The anatomical topography of STA-Fbr and MTV in temporal region is relatively regular, which has reference value for clinical practice. [ABSTRACT FROM AUTHOR]

Objective. The aim of this review was to present the vascular pattern of the STA, as well as anatomical variations, and to accentuate the areas which should be taken into consideration during manipulations along the course of the artery. Background. The STA may be encountered during several aesthetic procedures on the face, and iatrogenic trauma could be an incriminating factor of diverse sequelae. The constant increase in demand for facial aesthetic procedures has rendered it imperative to maximize safety and patient satisfaction. Methods. We conducted a narrative literature review using the electronic databases of PubMed and Google Scholar, retrieving studies concerning the anatomy and variations of the STA. Moreover, we identified registered clinical cases presenting complications which involved the artery. Discussion. The anatomic morphology of the STA is described and classification systems summarized, on the basis of the studies retrieved. In addition, the STA is related to defined landmarks, and specific danger zones are emphasized. Finally, the clinical significance of the artery is reflected in registered cases of adverse events following specific aesthetic surgeries. Conclusion. Thorough knowledge of the anatomical variability of the STA, and awareness of the danger zones involved in aesthetic procedures, combined with intraoperative vigilance could increase safety and minimize the advent of relevant sequelae. [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]

We present a case of a ruptured pseudoaneurysm of the superficial temporal artery (STA) after surgery for intracranial hemorrhage. To our knowledge, only three similar cases have been reported. A 47-year-old man underwent left frontal craniotomy for a left frontal subcortical hematoma. The left STA was not identified during the surgery, and no STA bleeding was observed. The postoperative course was uneventful for 20 days, until the patient experienced a left-side headache and noticed a subcutaneous mass. The mass increase in size within 1 hour and arterial hemorrhage was observed through a tear in the wound. Findings on subsequent contrast computed tomography were consistent with a ruptured pseudoaneurysm arising from the left STA. Emergency evacuation of the hematoma and STA ligation were performed. Pathological findings were consistent with a pseudoaneurysm. STA pseudoaneurysms occasionally grow rapidly and can cause massive hematoma. Surgeons should carefully monitor for evidence of a pseudoaneurysm after craniotomy, even in the absence of intraoperative bleeding from the STA. [ABSTRACT FROM AUTHOR]

Superficial temporal artery (STA) aneurysms are very rare compared to vascular aneurysms of other regions. They are divided into two as true and pseudo. Pseudoaneurysm were much more common and often depend on an etiological factor but spontaneous true aneurysms are extremely uncommon and the etiologic causes are not clear yet. We present a 91-year-old female patient who consulted to us with swelling in front of the ear; there was no history of previous surgery or any trauma. The patient had a pulsatile mass in the preauricular region, which started 4 years ago and growed faster for the last 2 months. There was a mass consistent with a saccular type aneurysm whose continuity was observed with the temporal artery in imaging studies. The mass was excised under general anesthesia. The patient whose pathological examination was a true STA aneurysm was discussed in the light of the literature. [ABSTRACT FROM AUTHOR]

The surgical technique of STA–MCA double bypass is used to improve blood flow supplied by the distal middle cerebral artery (MCA) to the cerebral territory. This retrospective study from a single center aimed to compare the outcomes following STA–MCA double bypass in 12 patients with recurrent ischemic stroke.

A traumatic pseudoaneurysm of the superficial temporal artery is a rare vascular lesion that typically occurs after blunt trauma to the temporal region. It accounts for only 1% of all traumatic aneurysms. These pseudoaneurysms need to be appropriately diagnosed and treated without delay as the patient can experience resulting symptoms of severe headache, facial nerve palsy, arterial bleeding, and/or bone erosion. Diagnosis can typically be made with history of trauma along with physical examination followed by confirmation with ultrasound or computer tomography angiogram. The treatment of choice is ligation and resection. We present a case of a 20-year-old male with identified pseudoaneurysm following facial trauma and mandibular fracture repair treated with multiple trials of sclerotherapy. In addition, this report will review additional management options and diagnosis techniques for superficial temporal artery (STA) pseudoaneurysms.

Teaching Point: A pseudoaneurysm of the superficial temporal artery is a rare complication of head injury in a child.

Background: Multiple factors have been proposed to affect the vessel ingrowth from the superficial temporal artery (STA) after Encephalo-Duro-Arterio-Synangiosis (EDAS)., Methods: This retrospective single-center analyses included patients with Moyamoya Disease (MMD) undergoing EDAS from January 1st, 2013, to December 31st, 2023. Evaluated variables included demographic characteristics, clinical presentation, technical details, modified Rankin Scale (mRS) scores, and radiographic outcomes. Univariate and multivariate analysis was performed to identify factors favoring the ingrowth of collaterals from the STA., Results: Forty adult patients with MMD, most commonly females (77.5 %) with a median age of 48, underwent 56 EDAS. The most common initial presentations were ischemic events (75.0 %), followed by hemorrhagic events (27.5 %) and seizures (7.5 %). Digital angiography performed at a median of 13.7 months post-procedure revealed collateral growth from the STA in 78.6 % of cases, with a Matsushima grade A identified in 35.7 % of the revascularized hemispheres. Univariate analysis showed more collaterals in patients with a larger preoperative STA diameter (p=0.035), higher Suzuki grades (p=0.021) and longer angiographic follow-ups (p=0.048). Patients with occlusion of the internal carotid artery (ICA; p<0.01), middle cerebral artery (MCA; p<0.01), or anterior cerebral artery (ACA; p<0.01) also had more collateral ingrowth. Multivariate analysis revealed that ICA occlusion (OR=6.54; 95 % CI=1.03-41.48) and ACA occlusion (OR=6.52; 95 % CI=1.02-41.67) as predictors of collateral ingrowth from the STA., Conclusion: ICA and ACA occlusion were associated with success after EDAS. Longer follow-ups and larger STA demonstrated significant association on univariate analysis, but lost significance after adjusting for other procedural characteristics., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Face reconstruction is exceptionally demanding for the best color and texture equivalence with minimal morbidity. Most defects result from tumors or trauma, and local flaps are typically used. A preauricular flap based on the superficial temporal artery (STA) is an alternative to the classically used retroauricular flap. We describe a case of an 80-year-old female presenting a frontotemporal squamous cell carcinoma and reconstructed with a preauricular superficial temporal artery (PASTA), reverse-flow, pedicled flap. It measured 5x6 cm and was based on the STA parietal branch instead of the more frequently reported frontal branch. The donor site was closed primarily. After 24 months, there were no complications, the aesthetic result was good, and the scar was inconspicuous. We also reviewed the literature for preauricular flap reports. A total of 152 preauricular STA flaps have been reported, mostly free flaps, for different facial areas, including ear cartilage or hair-bearing areas. Venous congestion is the most frequent complication. The PASTA flap is a simple solution for small-to-moderate facial defects, is easily harvested, has a straightforward dissection, can be reliably based on either a frontal or parietal branch, and provides an excellent texture and color match with minimal morbidity., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Health Ethics Committee, Coimbra Local Health Unit issued approval 218/CES Reg.005-2023. The Committee issues a favorable opinion. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Tomé et al.)

Introduction: The two most severe complications of single-stage, porous polyethene microtia reconstruction are flap necrosis/framework exposure and frontal nerve paralysis. To reduce these risks, require a temporoparietal fascia (TPF) flap that includes both the parietal and frontal branches of the superficial temporal artery (STA) while sparing the nerve. We propose a classification that helps minimize said complications., Material and Methods: Fifty-five TPF flaps of 54 microtia patients who underwent single-stage auricular reconstruction from May 2018 to July 2021 were studied. Flaps were harvested using endoscopic techniques. The parietal and frontal branch characteristics and measurements were obtained using a microscope/endoscope., Results: The frontal artery might have 1 to 4 branches. If they were close to Pitanguy's line (≤5 mm), there would be a high risk of nerve damage. Parietal (P) and frontal (F) artery diameters <0.5 mm were risk factors for partial flap necrosis. Based on this observation, we proposed 0.5 mm as the diameter threshold to determine whether an arterial branch is hypoplasia or sufficient. From this study, a new classification of STA branching pattern was proposed with five types: PF1 (23.6 %), PF2 (43.6 %), pF1 (3.6 %), pF2 (12.8 %), and Pf (16.4 %); where P/F indicates sufficient branches, p/f indicates absent or hypoplasia ones, and the number indicates single or multiple frontal artery branching., Conclusion: The risk of flap necrosis and frontal nerve damage is due to abnormalities of the frontal artery of the STA in the TPF flap. Understanding the anatomical classification with clear visualization during flap harvest ensures a successful outcome., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: To explore the diagnosis and treatment of traumatic external carotid branch pseudoaneurysms. Methods: Eleven cases of traumatic external carotid artery branch pseudoaneurysms were admitted in our hospital. Digital subtraction angiography was performed in all patients. It revealed that the pseudoaneurysms originated from the internal maxillary artery in 5 cases, superficial temporal artery in 5 cases and occipital artery in 1 case. Five cases of internal maxillary artery pseudoaneurysms and 2 cases of superficial temporal artery pseudoaneurysms were treated by embolization; the other 3 cases were surgically resected. Results: Complete cessation of nasal bleeding was achieved in all the 5 pseudoaneurysms of internal maxillary artery after the endovascular therapies. Scalp bleeding stopped and scalp defect healed up in 2 patients with superficial temporal artery pseudoaneurysms treated by interventional therapy. All patients were followed up for 0.5–2.0 years without recurrence of nosebleed and scalp lump. Conclusion: For patients with repeated severe epistaxis after craniocerebral injury, digital subtraction angiography should be performed as soon as possible to confirm traumatic pseudoaneurysm. Endovascular therapy is an effective method for traumatic internal maxillary artery pseudoaneurysms. For patients with scalp injuries and pulsatile lumps, further examinations including digital subtraction angiography should be performed to confirm the diagnosis. Surgical treatment or endovascular therapy for scalp traumatic pseudoaneurysm is effective.

Background To systematically summarize and critically review the available literature regarding the functional outcome of the urgent superficial temporal artery to the middle cerebral artery (MCA) bypass surgery in stroke patients associated with MCA lesions. Methods The current systematic review was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis statement. Medline (PubMed), ISI Web of Science, Scopus, and google scholar (manually searches) were systematically searched up to August 2021. The eligibility criteria were defined as all the patients who had MCA‐territory strokes due to MCA/intradural internal carotid artery lesions that underwent same‐admission superficial temporal artery‐MCA bypass surgery. The strokes with cervical internal carotid artery and anterior cerebral artery lesions/strokes were excluded. The checklists produced by the US National Heart Lung and Blood Institute were used for quality assessment. Demographic variables, clinical findings, National Institutes of Health Stroke Scale scores, the time interval between symptoms to surgery, imaging results, endovascular treatments, surgical notes, mortality rate, follow‐up findings, modified Rankin scale scores, and all reported medical records were extracted and analyzed with SPSS software (ver. 23). P values ≤0.05 were considered meaningful. Results The initial search yielded 3050 records, and 13 articles met the inclusion criteria and entered this systematic review. A total of 165 patients were pooled for data analysis. Nine studies had data regarding neurological deficits before and after surgery. Except for 5 patients, the National Institutes of Health Stroke Scale score after the operation was the same or better than the preoperative score. Eleven out of 17 patients in 3 studies showed early neurological improvement (a decrease in National Institutes of Health Stroke Scale score of ≥4 points at 3 days) after bypass surgery. Functional outcome was stated in 10 studies. Overall, a good functional outcome (modified Rankin scale=0–2) was achieved in 9 out of 21 (42.1%) patients at discharge and in 44 out of 59 (74.5%) patients at 3 months follow‐up. Lower age was associated with favorable outcomes. Long‐term graft patency was excellent in 99.5% of patients. Postoperative hematoma and mortality (all noncranial) rates were 3% and 3.6%, respectively. Conclusion The current study suggests that early superficial temporal artery‐MCA revascularization should be considered an available option in younger patients (

Traumatic arteriovenous fistulas (AVFs) are pathologic conditions caused by abnormal connection between an artery and a nearby vein following trauma to the region. In general AVF is rare in the superficial temporal artery. In this article, we report a case of arteriovenous fistula of Superficial temporal artery which was confirmed with 3D CTA and was treated surgically after six years of beginning.Arteriovenous fistula of Superficial temporal artery (STA) is not common, and the most important cause is trauma which causes a pulsatile mass in the temporal region after undeterminable time.We report here a case of a 12 year old child who came to the hospital seeking medical advice for a mass in his right temporal region that was growing progressively.The patient told us that this mass has appeared after a blunt trauma to his head six years ago.The patient underwent radiological examinations, and arteriovenous fistula of Superficial temporal artery (STA) was diagnosed.He underwent a complete surgical resection of the mass after ligation of the feeding artery and the draining vein.

Arteriovenous fistula (AVF) is a rare sequela following arthrocentesis of the temporomandibular joint. This case report discusses a constellation of symptoms, findings, and appropriate management of a patient with a superficial temporal AVF. Several findings in this case, including vertigo, nystagmus, and hearing loss, have not been previously documented in the literature. [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]