Assessment of the Temporopolar Artery as a Donor Artery for Intracranial-to-Intracranial Bypass to the Middle Cerebral Artery: Anatomical Feasibility Study

• Published in: World neurosurgery
• Main Authors: Tayebi Meybodi, Ali, MD, Lawton, Michael T., MD, Griswold, Dylan, Mokhtari, Pooneh, PhD, Payman, Andre, Tabani, Halima, MD, Yousef, Sonia, Kola, Olivia, Benet, Arnau, M.D
• Format: Journal Article
• Language: English
• Published: 2017
• Subjects: Neurosurgery; Orbitofrontal; PP; Posterior long gyrus; STA; Middle short gyrus; PT; TPA; Middle cerebral artery; PLG; Central; Angular; Posterior parietal; SD; ASG; Anterior parietal; OF; IC; Standard deviation; Anterior short gyrus; CA; AA; MSG; Intracranial; Temporooccipital; Middle temporal; PSG; Prefrontal; MT; MCA; Superficial temporal artery; Posterior temporal; Temporopolar artery; AP; Anterior long gyrus; PC; PF; Precentral; Posterior short gyrus; TO; ALG
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.04.142

Abstract Background Intracranial-intracranial bypass is a valuable cerebral revascularization option. Despite several advantages, one of the main shortcomings of the intracranial-intracranial bypass is the possibility of ischemic complications of the donor artery. However, when sacrificed, the temporopolar artery is not associated with major neurological deficits. We sought to define the role of TPA as a donor for revascularization of the middle cerebral artery (MCA). Methods A Pterional craniotomy was performed on 14 specimens. The TPA was released from arachnoid trabecula and the small twigs to the temporal lobe were cut. The feasibility of side-to-side and end-to-side bypass to the farthest arterial targets on insular, opercular, and cortical MCA branches was assessed. The distance of the bypass point was measured in reference to limen insulae. Results A total of 15 TPAs were assessed (one specimen had two TPAs). The average cisternal length of the TPA was 37.3mm. For side-to-side bypass, the TPA was a poor candidate as an intracranial donor, except for the cortical orbitofrontal artery which was reached in 87% of cases. However, the end-to-side bypass was successfully completed for most arteries (87-100%) on the anterior frontal operculum and more than 50% of the cortical or opercular middle and posterior temporal arteries. There was no correlation between the TPA’s cisternal length and maximum bypass reach. Conclusions When of favorable diameter, the TPA is a competent donor for IC-IC bypass to MCA branches at the anterior insula, and anterior frontal and middle temporal opercula (arteries anterior to the precentral gyrus axial plane).