Topographic Surgical Anatomy of the Para-Sylvian Anterior Temporal Artery for Intracranial-Intracranial Bypass

• Published in: World neurosurgery
• Main Authors: Meybodi, Ali Tayebi, MD, Griswold, Dylan, Tabani, Halima, MD, Lawton, Michael T., MD, Mokhtari, Pooneh, PhD, Payman, Andre, Benet, Arnau, MD
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Neurosurgery; Greater Sphenoid Wing; TPA; Middle cerebral artery; Aneurysm; STG; Anterior Temporal Artery; Sylvian fissure; GSW; ATA; IC-IC; Lesser Sphenoid Wing; Superior Temporal Gyrus; SCA; LSW; Temporopolar Artery; Superior Cerebellar Artery; MTA; Intracranial-intracranial bypass; Revascularization; Intracranial-Intracranial; Middle Temporal Artery
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2016.05.050

Abstract Background The anterior temporal artery (ATA) is an appealing donor artery for intracranial-intracranial (IC-IC) bypass procedures. However, its identification may be difficult. Current literature lacks useful landmarks to help identify the ATA at the surface of the sylvian fissure. Objective To define the topographic anatomy of the cortical segment of the ATA relative to constant landmarks exposed during the pterional approach. Methods The temporopolar (TPA), anterior temporal and middle temporal arteries (MTA) were examined in sixteen cadaveric specimens. The topographic anatomy and key landmarks of the arteries at the sylvian fissure were recorded. The distance between the point of emergence from the sylvian fissure to the lesser sphenoid wing (LSW) and anterior tip of the temporal lobe were measured. Also, the features of the inferior frontal -relative to each of the arteries at the sylvian fissure were recorded. Results The average distances from the LSW to the TPA, ATA and MTA were 3.7mm, 21.2mm and 37mm, respectively. The mean distances from the temporal pole were: TPA-14.7mm, ATA-32.0mm, and MTA- 45.4mm. The differences between the average distances were statistically significant (p < 0.0001). The ATA most frequently faced pars triangularis, whereas the TPA was always facing pars orbitalis. The MTA was always found posterior to the junction of pars triangularis and pars opercularis. Conclusion This report provides topographic evidence for efficient identification of the ATA in the para-sylvian space. The key relationship and landmarks identified in this article may increase efficiency and safety when harvesting the ATA for IC-IC bypass.