title: Anterior Temporal Artery-to-Anterior Cerebral Artery Bypass: Anatomic Feasibility of a Novel Intracranial-Intracranial Revascularization Technique.
abstract: BACKGROUND
  Complex aneurysms of the anterior cerebral artery (ACA) may require a bypass procedure as part of their surgical management. Most current bypass paradigms recommend technically demanding side-to-side anastomosis of pericallosal arteries or use of interposition grafts, which involve longer ischemia times. The purpose of this study is to assess the feasibility of an anterior temporal artery (ATA) to ACA end-to-side bypass.
  
  
  METHODS
  Fourteen cadaveric specimens (17 ATAs) were prepared for surgical simulation. The cisternal course of the ATA was freed from perforating branches and arachnoid. The M3-M4 junction of the ATA was cut, and the artery was mobilized to the interhemispheric fissure. The feasibility of ATA bypass to the precommunicating and postcommunicating ACA was assessed in relation to the cisternal length and branching pattern of the middle cerebral artery.
  
  
  RESULTS
  Successful anastomosis was feasible in 14 ATAs (82%). Three ATAs did not reach the ACA. These ATAs were branching distally and originated from the M3 (opercular) middle cerebral artery. In specimens where bypass was not feasible, the average cisternal length of the ATA was significantly shorter than the rest.
  
  
  CONCLUSIONS
  ATA-ACA bypass is anatomically feasible and may be a useful alternative to other revascularization techniques in selected patients. It is technically simpler than A3-A3 in situ bypass. ATA-ACA bypass can be performed through the same pterional exposure used for the ACA aneurysms, sparing the patient an additional interhemispheric approach, required for the A3-A3 anastomosis.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA.
authors.forename: Ali Tayebi
authors.initials: AT
authors.lastname: Meybodi
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lawton
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA.
authors.forename: Dylan
authors.initials: D
authors.lastname: Griswold
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA.
authors.forename: Pooneh
authors.initials: P
authors.lastname: Mokhtari
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Payman
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA.
authors.forename: Sonia
authors.initials: S
authors.lastname: Yousef
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA.
authors.forename: Halima
authors.initials: H
authors.lastname: Tabani
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, California, USA. Electronic address: beneta@neurosurg.ucsf.edu.
authors.forename: Arnau
authors.initials: A
authors.lastname: Benet
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D020771:Anterior Cerebral Artery / Q000601:surgery*; D002102:Cadaver; D002548:Cerebral Revascularization / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D013699:Temporal Arteries / Q000601:surgery*
keywords: Anastomosis; Anterior cerebral artery; Anterior temporal artery; Cerebral revascularization; Complex intracranial aneurysms; Intracranial-intracranial bypass