title: The superficial temporal artery trunk as a donor vessel in cerebral revascularization: benefits and pitfalls.
abstract: OBJECTIVE
  The superficial temporal artery (STA) is the mainstay of donor vessels for extracranial-intracranial bypass in cerebral revascularization. However, the typically used STA anterior or posterior branch is not always adequate in its flow-carrying capacity. In this report the authors describe the use of the STA trunk at the level of the zygoma as an alternative donor and highlight the benefits and pitfalls of this revascularization option.
  
  
  METHODS
  The authors reviewed the cases of 4 patients in whom the STA trunk was used as a donor site for anastomosis of a short interposition vein graft. The graft was implanted into the middle cerebral artery to trap a cartoid aneurysm in 2 patients, and the posterior cerebral artery for vertebrobasilar insufficiency in the other 2. Discrepancies in size between the interposition vein and STA trunk were compensated for by a beveled end-to-end anastomosis or by implanting the STA trunk into the vein graft in an end-to-side fashion.
  
  
  RESULTS
  Intraoperative flow measurements confirmed the significantly higher flow-carrying capacity of the STA trunk (54-100 ml/minute) compared with its branches (10-28 ml/minute). The STA trunk interposition graft has several advantages compared with an interposition graft to the cervical carotid, including a shorter graft and no need for a neck incision. However, in the setting of ruptured aneurysm trapping, with the risk of subsequent vasospasm, it is a poor conduit for endovascular therapies.
  
  
  CONCLUSIONS
  The STA trunk is a valuable donor option for cerebral revascularization, but should be avoided in the setting of subarachnoid hemorrhage.
authors.affiliation: Department of Neurosurgery, University of Illinois at Chicago, Illinois 60612-5970, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Alaraj
authors.forename: William W
authors.initials: WW
authors.lastname: Ashley
authors.forename: Fady T
authors.initials: FT
authors.lastname: Charbel
authors.forename: Sepideh
authors.initials: S
authors.lastname: Amin-Hanjani
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000601:surgery*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D018570:Risk Assessment; D013536:Suture Techniques; D013699:Temporal Arteries