Preservation and microsurgical repair of the superficial temporal artery during pterional craniotomy

• Published in: World neurosurgery Vol. 89; pp. 72 - 77
• Main Authors: Menovsky, Tomas, M.D., Ph.D, Sener, Suleyman, M.D, Kamerling, Niels, M.D, Plazier, Mark, M.D, Boogaarts, Jeroen, M.D, Lukes, Anton, M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2016
• Subjects: Brain Neoplasms - surgery; Cerebral Angiography; Cerebral Revascularization - adverse effects; Cerebral Revascularization - methods; Craniotomy - adverse effects; Craniotomy - methods; Humans; Intracranial Aneurysm - etiology; Intracranial Aneurysm - surgery; Magnetic Resonance Angiography; Microvascular anastomosis; Neurosurgery; Postoperative Complications; Pterional craniotomy; Superficial temporal artery; Surgical Instruments; Temporal Arteries - diagnostic imaging; Temporal Arteries - injuries; Temporal Arteries - surgery; Tomography, X-Ray Computed; Training; superficial temporal artery; pterional craniotomy; microvascular anastomosis; training; Microvascular anastomosis; Training; CT; STA; MRI; Superficial temporal artery; Pterional craniotomy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.01.012

Objective To study the rate of STA preservation and the effectiveness of STA reconstruction in patients undergoing a pterional craniotomy. Methods Included patients (n=136) underwent either an emergency or an elective pterional craniotomy. In case of deliberate transection or accidental damage of the STA, it was repaired microsurgically at the end of the procedure. Postoperatively, the patency of the STA was assessed complications related to wound healing were recorded. Results Of the 136 operated patients, the STA could be identified in 120 cases (88%). Of these 120 cases, the STA could be dissected and left undamaged in 60 patients (44%). In 52 patients (38%), one of the two branches of the STA had to be transsected in order to elevate the muscle-skin flap. Forty-six of the transected arteries could be anastomosed at the end of the procedure. All of these arteries were patent directly after repair. In the remaining 16 patients (12%), the STA was not identified during approach. All anastomosed arteries (n=46) were patent. Two patients developed a postop infection. Conclusions Preserving or reconstructing of the STA during pterional craniotomy is feasible in the majority of the patients with very high rate of anastomosis patency. STA hinders elevation of the skin/muscle flap in around 38 % of the pterional approaches and without reconstruction afterwards, the STA would been occluded.