Bilateral Superficial Temporal Artery Research Articles

P190 Protocolised ultrasonography led pathway has a high sensitivity for diagnosis of primary large vessel vasculitis

Abstract Background/Aims Ultrasonography (US) for diagnosis of large vessel vasculitis (LVV) is a recommended first line diagnostic procedure. Our county has an annual incidence of 57.5/million for primary LVV (giant cell arteritis (GCA) 48.3/million; Takayasu 2.5/million; unclassified LVV 6.4/million). Our protocolised fast-track US pathway has reduced visual loss from 18.7% to 11.5%. We present the results of our first 1000 unique referrals. Methods Unique requests for US from January 2017 were analysed. Protocolised US examination of the arteries includes superficial temporal artery (STA) and its rami, followed by the entire axillary artery, followed by other arteries as necessary. Halo sign in at least two different arteries was needed for diagnosis of LVV. A temporal artery biopsy (TAB) or positron emission tomography (PET) were requested if the US was negative AND CRP was ≥20mg/L (or missing) AND an alternate explanation for the raised CRP was not immediately apparent. For those where a second test was not requested OR if it was negative, prednisolone was tapered rapidly, and a patient-initiated follow-up allowed rapid re-assessment. If referring physician or patient did not want a second test, GCA was diagnosed on clinical grounds alone and the pathway was considered to have failed. Results Median age was 73 (IQR 13); 11/1000 referrals were for people <50 years of age. The median delay for the procedure was 4 (IQR 4) days. Prednisolone had been started a median of 4 (IQR 5) days previously. 279/1000 (28%) US scans demonstrated vasculitis. Pre-steroid CRP was ≥20mg/L in 283 cases and unavailable in 7. An alternate explanation for the raised CRP was found in 102 cases, 181 were referred for a second test, and 7 received a clinical diagnosis of GCA without a second test. The second test was diagnostic in 31/181 (17%) - 24/139 (17%) TAB, 7/42 (17%) PET. 3/150 cases with a negative second test and 4/431 cases with CRP <20mg/L were diagnosed with GCA on patient-initiated follow-up. The delayed diagnosis did not result in visual loss. 202/279 (72%) US positive cases had bilateral STA involvement. The addition of axillary artery imaging picked up a further 53 (19%) cases; 24/279 (9%) cases needed imaging of other arteries. The sensitivity and negative predictive value of the pathway are 96% (310/324) and 98% (683/690) respectively. Conclusion Our protocolised US led pathway for diagnosis of LVV is highly sensitive and allows disease exclusion with high certainty. Routine US of the superficial temporal artery and its rami, and the entire axillary artery provide diagnosis in 91% of cases but ability to scan more arteries improves yield in a further 9% of cases. Composite testing with US plus second test, stratified by CRP levels, can be recommended as a gold standard diagnostic tool for LVV. Disclosure C.B. Mukhtyar: None. G. Ducker: None. C. Beadsmoore: None. K. Sisson: None. C. Jones: None.

Spontaneous development and involution of a de novo pseudoaneurysm at the superficial temporal artery-middle cerebral artery bypass anastomotic site in a patient with moyamoya disease: illustrative case.

De novo pseudoaneurysm formation is a rare complication of extracranial-intracranial bypass surgery. The authors report the case of a 28-year-old male who presented with new-onset right temporal and occipital ischemia who was found to have bilateral proximal internal carotid artery occlusion with collateral vasculature formation consistent with moyamoya disease. The patient underwent bilateral superficial temporal artery-middle cerebral artery bypasses. A de novo pseudoaneurysm was found at the left-sided bypass distal anastomotic site recipient vessel 1 month after the surgery. The pseudoaneurysm demonstrated a progressive reduction in size and eventual complete involution at 6 months after surgery. Limited literature reports extracranial-intracranial bypass-associated aneurysms treated primarily with either clipping or resection and reanastomosis. The authors demonstrate, for the first time, a progressively benign natural history course of an extracranial-intracranial bypass distal anastomotic site pseudoaneurysm.

Manual superficial temporal artery compression using a circular plastic material for embolization of meningioma: illustrative case.

In meningiomas that occur in the high-convexity region, the superficial temporal artery (STA) frequently feeds the tumor, and when embolizing from the middle meningeal artery (MMA), the embolic material may not reach the tumor vessels because of the pressure gradient resulting from the STA blood flow, resulting in inadequate embolization. In this case, a circular plastic material was used to apply circumferential pressure around the parietal foramen to control blood flow to the tumor. A 45-year-old male underwent head magnetic resonance imaging that revealed a 2.2-cm meningioma in the right high-convexity region. Preoperative embolization was performed. When N-butyl-2-cyanoacrylate was injected from the right MMA while using a circular plastic material to compress the skin around the parietal foramen through which the bilateral STAs (the tumor feeders) flow, it was able to fully penetrate the tumor vessel and occlude the other feeders in a retrograde manner. The patient underwent tumor removal after embolization uneventfully. Manual compression of the STA using a circular plastic material is useful when the tumor is fed by the STA through the parietal foramen and is also applicable to transarterial embolization of dural arteriovenous fistulas fed by the STA or occipital artery.

Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case.

BACKGROUNDEosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by the presence of asthma and eosinophilia. Because cerebral aneurysm formation induced by EGPA is a rare occurrence, there is no established treatment strategy for this condition.OBSERVATIONSA 67-year-old female who was diagnosed with idiopathic eosinophilia 3 months ago developed de novo fusiform aneurysms in the left vertebral, left internal carotid, and bilateral superficial temporal arteries, as noted during a regular follow-up examination of a convexity meningioma. Pathological examination of the resected superficial temporal artery revealed eosinophilic granulomas, which led to the diagnosis of EGPA, as well as EGPA-induced aneurysm formation. As the partially thrombosed vertebral artery fusiform aneurysm enlarged, the compression of the medulla oblongata occurred despite intensive immunosuppressive therapy for 1 year. The patient underwent flow diversion therapy administered using the pipeline embolization device, resulting in complete disappearance of the aneurysm.LESSONSConsidering that the entire circumference of the aneurysmal wall is affected by necrotizing vasculitis, flow diverter therapy would be a reasonable and efficient approach for the treatment of EGPA-related aneurysms in cases in which the patient is nonresponsive to immunosuppressants.

Multiple Dural Arteriovenous Fistulas in the Superior Sagittal Sinus Region with Reversible Parkinsonism and Urinary Incontinence as Rare Presentations: A Case Report

Background: Dural Arteriovenous Fistula (DAVF), characterized by abnormally direct connections between meningeal arteries and meningeal veins or dural venous sinuses, is a rare subtype among the intracranial arteriovenous malformations. Although the clinical manifestations of DAVF are very variable depending on the locations and size of venous drainage, parkinsonism and urinary incontinence are rarely reported. Here, we present a rare case with parkinsonism and urinary incontinence secondary to DAVF. Case Presentation: A 50-year-old man was admitted for a progressively worsening weakness of his left lower limb over a year with urinary incontinence for four months. Neurological examination revealed rigidity and bradykinesia of the left upper limb without an obvious tremor. Magnetic resonance imaging exhibited diffuse white matter hyperintensities in bilateral centrum semiovale. Cranial magnetic resonance venography revealed extensive tortuous venous malformations. Digital subtraction angiography exhibited multiple bilaterally distributed DAVF in the superior sagittal sinus, supplied by bilateral occipital arteries and superficial temporal arteries. In the one year follow-up, the patient with multiple DAVF bilaterally distributed was completely cured after endovascular treatment according to the symptoms and the follow-up imaging results. Conclusion: This report enriches the clinical presentations of DAVF with parkinsonism and urinary incontinence, which is a crucial diagnostic clue to be aware of the possibility. Moreover, these rare symptoms can be relieved by timely endovascular treatment.

Reconstruction of a large nasal–facial defect using an augmented temporal myocutaneous tube flap in a dog

The muzzle region of dogs contains various composite tissues, which are challenging to recreate during reconstruction. Small or moderate facial/nasal defects can be closed primarily or left for second‐intention healing. However, larger defects require the application of composite tissue or labial advancement flaps. Axial pattern flaps based on the caudal auricular artery, superficial temporal artery (STA), angularis oris artery, and other cutaneous arteries have been reported. In our case, we aim to report the reconstruction of a large composite defect of the rostral and dorsal nasal regions in a dog using an augmented, axial myocutaneous flap based on bilateral STAs. This is a clinical report on a spayed female mixed‐breed dog (age, 7 years; weight, 15 kg), in which a large‐scale nasal–facial composite tissue defect was surgically reconstructed using an axial myocutaneous flap based on bilateral STA branches. A delay technique was applied to prefabricate the flap to enrich the blood supply. New nostrils were created on a folded, rostral hard palate. As a result, the axial tube rotational flap was successfully transferred. The use of delay technique for prefabricating the tube flap optimized its size and survival. In addition to the folded rostral hard palate, the flap fully closed the defects on the face and nose. Functional and cosmetic outcomes were satisfactory, with minimal donor‐site morbidity. In, conclusion, a large‐scale nasal–facial defect in a dog was successfully reconstructed using an augmented tube pedicle flap based on the bilateral STAs, which may, thus, be used to repair very large facial‐nasal defects in dogs.

Successful Treatment of Intra-Arterial Peplomycin Infusion for Recurrent Oral Florid Papillomatosis

A 56-year-old woman had noticed the erosion of oral mucosa and tongue 8 years ago. The mucosal lesions had been initially diagnosed as oral lichen planus and resistant to various treatments with prednisolone, etretinate and mizoribine and so on. One year ago, rapidly growing verrucous lesion occurred on her upper lip. Although we administered intralesional radiation therapy, the tumor recurred and new whitish lesions on the buccal mucosa and hard palate occurred 9 months after treatment. We confirmed an anatomical blood supply to the tumors by a fluorescent real-time imaging system and subsequently administered the intra-arterial infusion of peplomycin through retrograde catheters from bilateral superficial temporal arteries under the final diagnosis as oral florid papillomatosis (OFP). The tumors were dramatically shrunk and did not recur 16 months after treatment. OFP is known as clinically multiple whitish and verrucous lesions over the oral cavity and lip and a subtype of SCC with high differentiation. We suppose that an intra-arterial infusion therapy of peplomycin should be considered as the curative treatment for OFP.

Epilepsy surgery for a patient with neurofibromatosis type 1 concomitant with moyamoya syndrome

BackgroundEpilepsy associated with neurocutaneous disorders is well known, and the prevalence of epilepsy among patients with neurofibromatosis type 1 (NF1) ranges from 4% to 13%. However, epilepsy surgery for patients with NF1 is not commonly performed. Case descriptionWe report the case of a patient with medically intractable mesial temporal lobe epilepsy (mTLE) concomitant NF1 and moyamoya syndrome (MMS) who had already undergone bilateral superficial temporal artery-middle cerebral artery anastomosis at 17 years old. As the standard temporal approach was unavailable, we evaluated the patient with neurologists, radiologists, neurosurgeons and neuropsychologists to identify the safest trajectory for epilepsy surgery. The patient underwent the right selective amygdala hippocampectomy from the posterior auricle part at 32 years old and obtained freedom from seizures. ConclusionTo the best of our knowledge, this represents the first surgical case report for mTLE concomitant with NF1 and MMS.

Single-Stage Direct Revascularization for Bilateral Anterior Cerebral Artery Regions in Pediatric Moyamoya Disease: A Technical Note

The authors present cases of childhood moyamoya disease successfully treated with bilateral superficial temporal artery to anterior cerebral artery (ACA) direct anastomoses and describe the surgical techniques used in this vascular reconstruction method. The authors conducted bilateral superficial temporal artery to ACA anastomoses, combined with indirect bypass in 3 pediatric patients with moyamoya disease from 2009 to 2015. All 3 patients presented with transient ischemic attacks related to ischemia of the ACAs and had cerebral blood flow insufficiency, predominantly in the ACA regions bilaterally. In all 3 cases, ischemic symptoms corresponding to ACA ischemia had disappeared after bypass surgery. No patients experienced any postoperative neurologic or wound complications associated with the procedure. Improvement of cerebral blood flow in bilateral ACA territories and the patency of the direct bypasses were confirmed by follow-up imaging in all 3 patients. The described technique can be considered an effective and uncomplicated revascularization procedure for the ACA regions, which are crucial for normal intellectual growth in the pediatric population.

Hard plate cancer treated with superselective intra-arterial chemoradiotherapy via bilateral superficial temporal arteries: a case study

Hard plate cancer treated with superselective intra-arterial chemoradiotherapy via bilateral superficial temporal arteries: a case study

Increased Ratio of Superficial Temporal Artery Flow Rate After Superficial Temporal Artery-to-Middle Cerebral Artery Anastomosis: Can It Reflect the Extent of Collateral Flow?

There are several ways to identify donor artery patency and success of surgery after an anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA). The purpose of this study was to evaluate the ratio of bilateral STA mean flow rate (MFR) with the use of color Doppler ultrasonography (CDUS) after bypass surgery and to confirm the possibility of this value as a predictor of the extent of collateral flow. Eleven consecutive patients who had undergone STA-MCA anastomosis were included. In every case, bilateral STA MFR, mean velocity, and cross-sectional diameter were measured preoperatively and postoperatively at 1 week, 1 month, and 2 months via CDUS. We measured the bilateral STA MFR ratio changes to compensate for systemic hemodynamic variables. One month after surgery, 9 of the 11 patients who underwent STA-MCA anastomosis had good patency on DSA. In patients with good patency, there was a significant increase in the baseline STA MFR ratio compared with those at 1 week, 1 month, and 2 months postoperatively (2.88, 3.07, and 4.38, respectively, P < 0.05). The mean STA cross-sectional diameter ratio also was significantly increased postoperatively in the good patency group (1.35, 1.41, and 1.49, respectively, P= 0.044). In addition, the mean STA mean velocity ratio was increased postoperatively in the good patency group (1.48, 1.40, and 1.67, respectively, P= 0.042). We conclude that using CDUS to measure both STA MFR ratio is a potential method to predict the extent of collateral flow through an STA-MCA anastomosis.

Onyx removal after embolization of a superior sagittal sinus dural arteriovenous fistula involving scalp artery.

Background:Most dural arteriovenous fistula (DAVF) in superior sagittal sinus (SSS) requires multimodal treatment. Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk.Case Description:A 59-year-old male presented with involuntary movements of both legs and progressive dementia. Cerebral angiography demonstrated the DAVF in the SSS fed by bilateral superficial temporal, occipital, and middle meningeal arteries. The posterior SSS was thrombosed, and the main drainers were cortical veins. Combined treatment with transarterial embolization using Onyx and transvenous embolization using coils was performed. Although symptoms were improved, a small DAVF remained. Two months later, Onyx cast extrusion through the scalp was observed, requiring removal and debridement because of infection at the extrusion sites. Surgery for the residual DAVF would be difficult because of scalp condition; therefore, an additional endovascular treatment was conducted, completely occluding DAVF.Conclusion:Onyx embolization is useful for DAVF; however, scalp artery embolization has cast extrusion risk. Therefore, scalp infection should be considered because it may preclude additional surgical procedures.

Novel Surgical Technique for Full Face Transplantation

Full face transplantation raises a new set of ethical concerns and technical difficulties when compared with partial face transplantation. Previously, it was thought that full face allografts must include bilateral superficial temporal and facial arteries, dictating the need for inclusion of donor parotid glands. This would lead to poor aesthetic outcomes and limit facial nerve coaptation to the level of the main trunk, which often results in synkinesias. The authors present a new approach to full facial allograft recovery based on blood supply from facial arteries alone. This approach eliminates the need to include parotid glands, enabling more distal coaptation of facial nerve branches and targeted innervation of effector muscles. The recovery can be reproducibly performed within 4 hours. Three mock cadaver dissections and three full face transplantations were performed. Donor facial allografts were dissected in cranio-caudal and lateral-to-medial fashion. Individual facial nerve branches were cut medial to parotid glands and coapted to corresponding recipient nerve branches. With the exception of one parotid gland used to add bulk, parotids were generally not included in the allografts. Relevant sensory nerves were coapted. External carotid arteries were dissected, leaving only bilateral facial arteries as the primary arterial supply. All full facial allografts were well perfused immediately following transplantation and are surviving. The authors describe a new, simple, and reproducible technique of full facial allograft recovery that allows perfusion using only bilateral facial arteries. Their technique follows critical principles of targeted sensory and motor nerve coaptation.

Moyamoya Disease in Pregnancy: Management after Intracranial Bypass Grafting

Moyamoya disease (MD) is a chronic, progressive cerebrovascular disease distinguished by bilateral stenosis or occlusion of the arteries around the circle of Willis with resulting prominent arterial collateral circulation. We describe a pregnant woman in whom this diagnosis was confirmed by cerebral angiogram and treated with bilateral superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting prior to conception. The patient was managed with strict blood pressure monitoring and low-dose aspirin antepartum, intrapartum, and postpartum. The patient presented in spontaneous labor at term and underwent a spontaneous vaginal delivery without complications.

Repair of cervicofacial scar by forehead expansive skin flap double-pedicled with superficial temporal vessels

To explore the clinical efficacy of using forehead expansive skin flap double-pedicled with superficial temporal vessels for repairing male cervicofacial scar. From July 2005 to June 2009, 13 male patients with an average age of 27 years old (range: 21 - 38) were operated by the above method. The scar-repairing area was from 14 cm × 5 cm to 32 cm × 15 cm. The procedure was carried out in three stages. Firstly, ultrasound Doppler was used to detect and mark the location and orientation of superficial temporal artery. A proper cavity was created under the forehead muscle and then the appropriate expander embedded through the scalp incision. The expander was expanded first by injecting normal saline at 1 or 2 weeks post-operation. After that, the injection was repeated by 3 or 5 days. The volume ratio of injection to expander was (1.5-3.5):1. Secondly the forehead expansive skin flap was designed with proper hair follicle scalp pedicled by bilateral superficial temporal artery when the expansion was completed. After removal of the expander, the rectangle expansive skin flap with hair follicle scalp was transferred through the double pedicle. The cervicofacial scar was excised according to the size of the transferred expansive skin flap (25 cm × 6 cm to 32 cm × 9 cm). And the flap was adjusted with hair follicle scalp to the middle of the chin area in order to obtain the normal beard appearance. Donor site were closed directly. Thirdly, the pedicle skin flap were cut and restored after one month. The volume expanded for each expander ranged from 420 to 800 ml (mean: 660). The average expansion time was 4 months (range: 3 - 5). All flaps survived well. Donor site were closed directly. Both chin and beard looked normal. Repairing hypertrophic scar and reconstructing beard in cervicofacial area with forehead expansive skin flap pedicled by bilateral superficial temporal artery is a valuable and safe method. The donor site is scarless. And the reconstructed chin and beard are normal both functionally and aesthetically.

Bilateral Superficial Temporal Artery Aneurysms

Aneurysms of the superficial temporal artery are rare and most often traumatic in origin. In this case study we present an extremely rare occurrence of bilateral nontraumatic superficial temporal artery aneurysms. Spontaneous bilateral superficial temporal artery aneurysms have not been previously reported. The patient was a 49-year-old woman who presented to our outpatient vascular lab with pulsating masses noted over bilateral temporal regions. Duplex ultrasound revealed a 2.3 mm right and 4.5 mm left temporal artery aneurysm. The aneurysms were subsequently resected and the patient recovered without incident. Non-invasive duplex ultrasound is an effective method in identifying these rare aneurysms. A literature search revealed few published cases of non-traumatic STAs and of these cases none involved bilateral vessels.

Isolated Superficial Temporal Artery Dissection Masquerading as Giant Cell Arteritis

A 79-year-old male presented with symptoms suggesting giant cell arteritis (GCA) and elevation of acute-phase reactants. Bilateral superficial temporal artery (STA) biopsies were negative for GCA. However, the right-sided biopsy showed a STA dissection. Spontaneous isolated STA dissection has never been reported previously. The pertinent available literature is also discussed.

Huge, alarming congenital hemangioma of the scalp presenting as heart failure and Kasabach-Merritt syndrome: a case report

We report on a neonate with a huge congenital hemangioma of the scalp presenting as high-output heart failure and Kasabach-Merritt syndrome. The condition was successfully treated by means of surgical excision. A prematurely born (gestational age=36 weeks; birth weight=2,316 g), three-day-old female infant was referred to our institution for a huge scalp tumor (Fig. 1), already detected by fetal ultrasonography at six months of gestation. Head computed tomography scan revealed a hypervascular tumor of the scalp with strong heterogeneous enhancement. Magnetic resonance imaging demonstrated multiple feeding arteries, mainly consisting of an anastomosis of bilateral superficial temporal arteries and branches of the internal carotid artery. There was no evidence of intracranial hemorrhage. The patient had early heart failure signs including progressive respiratory distress and tachycardia. A small patent ductus arteriosus was present (1.2 mm in size). Thrombocytopenia (134 10/L) on the 1st day of life progressed to the lowest level (107 10/L) on day 3. On day 4, normocytic anemia (hemoglobin=11.5 g/dL) was present, prothrombin time was prolonged (16.3 seconds) as was partial thromboplastin time (79 seconds). Direct Coombs_ test was negative and both fibrin split products (80–160 mg/ml; normal<10 mg/ml) and D-Dimer (1.94 mg/ml; normal<0.5 mg/ml) were increased. The early heart failure signs improved soon after oxygen hood. Dopamine (5 mg/kg/min) and parenteral furosemide were administered beginning on the 3rd day of life. On the 5th day of life surgical excision following ligation of the feeding arteries was successful apart from the need for a whole-blood transfusion for surgery-related blood loss of approximately 300 mL. Indirect hyperbilirubinemia on the day subsequent to surgery complicated patient recovery, followed by the need for a double-volume blood-exchange transfusion in order to deal with a total bilirubin level escalating to 23.8 mg/dL. The patient_s thrombocytopenia resolved from the 14th day of life. Dopamine and furosemide were discontinued three days following surgery and the baby was discharged in good condition two weeks later. The histological findings from the excised lesion revealed a number of vascular channels located beneath the scalp and surrounded by fibrotic and myxoid stroma. Low cellularity and scant mitotic figures were noted without any malformed vessels. Hemangioma is present in more than 10% of normal newborns with a strong female predominance [4]. Approximately 60% of the hemangiomas of infancy appear on the head and neck [3], ninety-five percent will regress spontaneously without sequelae [1]. By contrast, 3–5% of hemangiomas involve vital organs or produce life-threatening complications requiring the need for aggressive therapy [5]. The management of hemangioma is generally divided into conservative treatment and intervention therapy. A response rate to treatment of 45%, but a cure rate of only 18% has been reported following prednisone therapy (3–10 mg/kg/day) for six to eight weeks [5]. Serious side effects of interferon-a limit its use to life-threatening cases [2]. We chose direct surgical intervention for our patient, mainly Eur J Pediatr (2007) 166:619–620 DOI 10.1007/s00431-006-0278-x

Recurrent lymphocytic hypophysitis and bilateral intracavernous carotid artery occlusion. An observation and review of the literature

Objectives: Bilateral carotid artery occlusion associated with lymphocytic hypophysitis is exceedingly rare. We describe this association and review the literature.Methods: The authors describe a 38-year-old woman with a history of severe headaches. Magnetic resonance (MR) imaging showed an intrasellar mass with invasion of both cavernous sinuses. Lymphocytic hypophysitis was diagnosed by transphenoidal biopsy. In the course of the disease, she developed symptoms of cerebral ischemia attributable to bilateral occlusion of her internal carotid arteries in both cavernous sinuses. She underwent bilateral superficial temporal artery-middle cerebral artery bypass surgery.Results: The patient experienced progressive neurological recovery after surgery. A literature search revealed no other cases describing this unique association.Conclusions: Bilateral carotid artery occlusion may develop in the course of lymphocytic hypophysitis with cavernous sinus involvement. If indicated, cerebral revascularization should be performed to reverse cerebral ischemia.

Low diagnostic yield with second biopsies in suspected giant cell arteritis.

The clinical diagnosis of giant cell arteritis may be confirmed with a biopsy of the superficial temporal artery. Because of "skip lesions," a histologic diagnosis of giant cell arteritis may be missed with a unilateral biopsy. The authors report a study that investigates whether a biopsy of the contralateral superficial temporal artery provides any additional information for confirmation of a diagnosis of giant cell arteritis. Available medical records of 91 consecutive patients who underwent bilateral superficial temporal artery biopsy procedures were reviewed. Information that was abstracted included sequence of biopsy procedures, length specimens, and histologic diagnosis. Microslides from all biopsy specimens were retrieved and reexamined in a masked fashion by the ocular pathologist (RCE) who had made the original diagnoses. Seventy-two bilateral simultaneous superficial temporal artery biopsies and 19 bilateral sequential biopsies were performed. The mean length of biopsy specimens was 23 mm, and the mean length of the total artery removed from each patient was 33 mm. The pathologist's original diagnosis and the diagnosis at reexamination were in 100% agreement. In 90 (99%) of the 91 patients, the histologic diagnoses in the left and right superficial temporal arteries were the same. This is a concordance rate of 98.9% (38 of 39 positive biopsy results) among the positive biopsy results. There is a low yield of information from a second temporal artery biopsy in patients with suspected giant cell arteritis. This suggests that patients who present to the ophthalmologist with possible giant cell arteritis will, in most cases, have a similar diagnosis on both temporal artery biopsies if the specimens are adequate.