title: "Target bypass": a method for preoperative targeting of a recipient artery in superficial temporal artery-to-middle cerebral artery anastomoses.
abstract: OBJECTIVE
  To introduce a method for preoperative targeting of a proper recipient artery in superficial temporal artery-to-middle cerebral artery anastomosis.
  
  
  METHODS
  Six operations for superficial temporal artery-to-middle cerebral artery anastomosis in four patients with moyamoya disease or moyamoya-like disease and two operations in two patients with atherosclerotic cerebrovascular occlusive disease accompanied by coronary artery stenosis were performed using our method. Before surgery, a 3-Tesla magnetic resonance imaging study was performed with axial T1-weighted three-dimensional magnetization-prepared rapid acquisition gradient-echo sequences and three-dimensional time-of-flight magnetic resonance angiography. Data on quantitative regional cerebral blood flow were obtained by iodine-123-labeled N-isopropyl-iodoamphetamine single-photon emission computed tomography or positron emission computed tomography. The magnetic resonance angiography and regional cerebral blood flow data sets were registered with the magnetization-prepared rapid acquisition gradient-echo data set by means of the coregistration function of the SPM2 software. We examined the arteries located on or near the cortex where the regional cerebral blood flow had significantly decreased and used the coregistered data set and MRIcro software to select the cortical artery with the largest diameter as the target recipient artery. At the surgery, the data sets were applied to the neuronavigation system and the actual site of the target was confirmed in the operation before scalp incision. The superficial temporal artery was anastomosed with the target through a small craniotomy.
  
  
  RESULTS
  Successful bypass surgery to the target was confirmed in all cases.
  
  
  CONCLUSIONS
  The "target bypass" method might be effective for cases with moyamoya disease or for cases requiring surgery through a small craniotomy.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. kikuta@kuhp.kyoto-u.ac.jp
authors.forename: Ken-ichiro
authors.initials: K
authors.lastname: Kikuta
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Fushimi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Ishizu
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Okada
authors.forename: Takashi
authors.initials: T
authors.lastname: Hanakawa
authors.forename: Yukio
authors.initials: Y
authors.lastname: Miki
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nozaki
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
mesh_terms: D000328:Adult; D000368:Aged; D002539:Cerebral Arterial Diseases / Q000175:diagnosis* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D013699:Temporal Arteries / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome