title: Virtual surgical planning for superficial temporal artery to middle cerebral artery bypass using three-dimensional digital subtraction angiography.
abstract: OBJECTIVE
  To introduce reliable and minimally invasive virtual surgical planning for superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery using three-dimensional (3-D) rotational reconstruction digital subtraction angiography (DSA).
  
  
  METHODS
  Twenty-eight consecutive patients (11 women and 17 men) with cerebrovascular insufficiency due to internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion (n = 16), ICA or MCA stenosis (n = 6), and moyamoya or moyamoya-like disease (n = 6) underwent rotational DSA. Anatomical locations of the appropriate donor branch of the STA, the most suitable recipient of MCA and squamous sutures on the skull surface, were visualized using 3-D reconstruction imaging. Localization of the minicraniotomy, the skin incision on top of the superficial temporal artery branch, and the anastomosis point were accurately determined by virtual surgical planning.
  
  
  RESULTS
  According to preoperative assessments, the minimum necessary skin incision and small craniotomy were successfully achieved. The preselected artery was found without additional craniotomy and anastomosed at the putative point in all patients. Perioperative complications did not arise and all bypasses remained patent on follow-up.
  
  
  CONCLUSIONS
  Preoperative 3-D virtual surgical planning assessments are exactly consistent with operative findings. Such assessments avoid unnecessary manipulation and simplify the surgical procedure. This imaging technique is helpful for planning STA-MCA bypass surgery.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Nara, Japan. nakagawa@nmu-gw.naramed-u.ac.jp
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kurokawa
authors.forename: Megumi
authors.initials: M
authors.lastname: Tanisaka
authors.forename: Ryota
authors.initials: R
authors.lastname: Kimura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D013699:Temporal Arteries / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000601:surgery; D014584:User-Computer Interface; D055815:Young Adult