J Korean Neurosurg Soc.  2024 Mar;67(2):158-165. 10.3340/jkns.2023.0125.

Assessing the Adequacy of Superficial Temporal Artery Blood Flow in Korean Patients Undergoing STA-MCA Anastomosis

• Eun J
• Park IS

• KMID: 2553121
• DOI: http://doi.org/10.3340/jkns.2023.0125

Abstract

Objective
: Superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is conducted for flow augmentation. In this study, we measured the STA cut flow of a Korean population and evaluated the relationship between STA cut flow and long-term patency of the bypass.
Methods
: A retrospective study was conducted. Intraoperative measurement of STA flow was conducted using a microvascular flow meter on patients who underwent STA-MCA. After cutting the distal end, the STA flow rate was measured with no resistance and recorded. After finishing anastomosis, STA flow was measured and recorded. The cut flow index was calculated by dividing post anastomosis flow by cut flow in intracranial atherosclerotic stenosis patients.
Results
: The median STA cut flow was 35.0 mL/min and the post anastomosis flow was 24.0 mL/min. The cut flow of STA decreased with aging (p=0.027) and increased with diameter (p=0.004). The cut flow showed no correlation with history of hypertension or diabetes mellitus (p=0.713 and p=0.786), but did correlate a positively with history of hyperlipidemia (p=0.004). There were no statistical differences in cut flow, STA diameter, and post anastomosis flow between the frontal and parietal branches (p=0.081, p=0.853, and p=0.990, respectively).
Conclusion
: The median STA cut flow of a Korean population was 35 mL/min. Upon reviewing previous articles, it appears that there are differences in the STA cut flow between Western and Asian patients.

Keyword

Cerebral revascularization; Cerebrovascular circulation; Cerebral infaction

Figure

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  Fig. 1. Operative method of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis. A : The vascularized galeal flap was harvested using a Metzenbaum scissors. B : Immediately after harvest, blood flow is low. C : Removing fibrous soft tissue covering the STA. D : After removing fibrous soft tissue covering the STA and applying papaverine, the cut flow increased gradually. E : Using microvascular flow-meter, cut flow of STA was measured. F : End-to-side anastomosis of STA-MCA was performed.

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  Fig. 2. The cut flow value of superficial temporal artery (STA) over time. One hundred thirty cases showed a gradual increase in STA cut flow after application of papaverine (blue). One hundred twenty-eight cases required release of perivascular fibrous tissue surrounding the STA. Release of the perivascular soft tissue took an average of 10 minutes (dashed).

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  Fig. 3. Scatterplot of cut flow according to diameter of superficial temporal artery.

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  Fig. 4. The cut flow of the frontal and parietal branches.

Reference

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