Contralateral Superficial Temporal Artery Research Articles

Postoperative vascular event prediction using angiography and ultrasonography in patients with Moyamoya disease

ObjectiveIndirect revascularization surgery reduce the risk of recurrent vascular events in patients with moyamoya disease (MMD), but the roles of postoperative angiography and ultrasonography in predicting these events remain unclear. MethodsThis prospective study enrolled patients with MMD who would undergo their first unilateral indirect revascularization surgery. They received preoperative and postoperative ultrasound examination at 1, 3, and 6 months and conventional cerebral angiography. On ultrasonography, postoperative emerging flow (PEF) in an intracranial artery was defined as emerging flow postoperatively with absence of flow preoperatively. Predictors of vascular event frequency reduction were identified from angiographic and ultrasonographic parameters. ResultsIn total, 52 patients (including 24 pediatric and 24 male patients), who underwent 52 preoperative and 82 postoperative ultrasound examinations, were enrolled. Significant postoperative changes were noted in all the ultrasonographic parameters of ipsilateral superficial temporal artery (STA) and the end-diastolic velocity and flow volume in contralateral STA. During a median follow-up of 5.3 years, indirect revascularization surgery significantly reduced the occurrence of ipsilateral vascular events. Predictors of vascular event frequency reduction included Matsushima grade A or B on the ipsilateral side on angiography (odds ratio [OR] = 22.00, P = 0.002) and lower resistance index (RI) in ipsilateral STA (OR = 0.0001, P = 0.012) but no PEF pattern in ipsilateral middle cerebral artery (OR = 0.14, P = 0.029) on ultrasonography performed within 6 months. ConclusionsReduction of long-term vascular event frequency probably can be predicted through postoperative angiography and ultrasonography within 6 months after indirect revascularization surgery.

Revascularization techniques in surgical treatment of large and giant anterior cerebral artery aneurysms: literature review

Despite common use of revascularization for aneurysms of other locations, the role of bypass has been ignored for long time. In this study we describe actual status of revascularization in surgical treatment of ACA aneurysms based on an analysis of current literature. Search of literature was performed in data bases PubMed and Web of Science. Treatment of 80 patients in 24 articles was evaluated. In situ A3‑A3 bypass and extra — intracranial bypass with the superficial temporal artery are the most used techniques. The contralateral superficial temporal artery is the most convenient interposition graft for bypasses performed in patients with ACA aneurysms. There are no significant differences between extra-intracranial and intra-intracranial bypasses in terms of bypass patency and ischemic complications. The choice between different bypass techniques is based on an individual patient anatomy and surgeon preference.

Cross-Comparison of 4-Dimensional Flow Magnetic Resonance Imaging and Intraoperative Middle Cerebral Artery Pressure Measurements Before and After Superficial Temporal Artery-Middle Cerebral Artery Bypass Surgery.

The hemodynamic changes after superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery are unclear. To clarify the hemodynamics by comparing flow parameters obtained by 4-dimensional (4D) flow magnetic resonance imaging (MRI) and intraoperative MCA pressure measurement. We recruited 23 patients who underwent STA-MCA bypass surgery for internal carotid artery (ICA) or MCA stenosis. We monitored intraoperative MCA, STA, and radial artery (RA) pressure. All patients underwent 4D flow MRI preoperatively and 3 wk after surgery to quantify the blood flow volume (BFV) of the ipsilateral ICA (BFViICA), contralateral ICA (BFVcICA), basilar artery (BFVBA), ipsilateral STA (BFViSTA), and contralateral STA (BFVcSTA). The sum of intracranial BFV was defined as BFVtotal. We compared BFV parameters and intraoperative pressure. BFViSTA significantly increased after surgery (P<.001). BFViICA and BFVBA significantly decreased after surgery (BFViICAP=.005; BFVBAP=.02). No significant difference was observed between BFVcICA before and after surgery. As a result, BFVtotal postoperatively increased by 6.8%; however, no significant difference was observed. Flow direction at M1 changed from antegrade to unclear after surgery in 5 patients. Intraoperative MCA pressure and MCA/RA pressure ratio significantly increased after surgery (P<.001). We found a stronger positive correlation between MCA pressure increase ratio and BFVtotal increase ratio in patients with lower pre-MCA pressure (r=0.907, P<.001). The visual and quantitative assessment of 4D flow MRI revealed that intracranial blood flow changes complementarily after STA-MCA bypass surgery. 4D flow MRI may detect the improvement of cerebral perfusion pressure.

Bonnet Bypass for Left Superficial Temporal Artery Bifurcation to Right Middle Cerebral Artery: 2-Dimensional Operative Video.

A bonnet bypass is a long interposition graft bypass used for extracranial to intracranial revascularization, which is useful in patients who do not have a suitable ipsilateral donor or in whom the ipsilateral donor must be sacrificed. This interposition graft is commonly the radial artery or saphenous vein. The only practical difference in this technique for revascularization is that an interposition graft must pass through the subgaleal space to the contralateral scalp to allow for reimplantation at the desired contralateral point of anastomosis. This patient underwent a bonnet bypass for revascularization of the middle cerebral artery (MCA) perfusion territory utilizing the contralateral superficial temporal artery (STA). A saphenous vein was used as the interposition graft, which was anastomosed to an M2 segment bifurcation. The graft was then temporarily occluded and passed within a calvarial trough to the contralateral frontoparietal region. The graft was then anastomosed to the contralateral STA at a bifurcation to accommodate the graft size mismatch. The patient tolerated the bypass procedure well and demonstrated bypass patency on postoperative angiographic imaging. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Revascularization for Cerebral Ischemia, Step-by-Step Demonstration of Bonnet Bypass: 3-Dimensional Operative Video.

The superficial temporal artery (STA) to the middle cerebral artery (MCA) bypass is the most common bypass type for revascularization to treat cerebral ischemia. If the ipsilateral STA is not available for anastomosis, various options for bypass conduits can be exercised. When the entire ipsilateral external carotid and its branches are not available, the contralateral STA may be used as a donor artery through an interposition graft. This technique is known as a "bonnet bypass." In this video, we demonstrate the utilization of a bonnet bypass in a 48-yr-old man with protein S deficiency, and right carotid artery occlusion with recurrent strokes and transient ischemic attacks (TIA). After exhausting nonsurgical options by treating with 2 antiplatelet drugs and supportive lifestyle changes, the patient continued to experience TIAs and watershed strokes in the right hemisphere. Angiography showed that the right anterior artery and the MCA were filled through the Circle of Willis, but the ipsilateral STA and entire external and common carotid arteries were not patent for potential use as a bypass donor. Since the ipsilateral bypass options were not available, we elected to perform a bypass from the contralateral STA trunk to the ipsilateral M2 with a saphenous vein interposition graft, for a so-called bonnet bypass. The patient did well after surgery and has remained symptom-free for 19 mo post bypass. The surgical technique and each step in performing this bonnet bypass are demonstrated in this 3-dimensional video. The patient consented to the publication of his operative video.

Time-of-flight MRA signal intensity predicts the cerebral hemodynamic status after superficial temporal artery to middle cerebral artery anastomosis

Arterial signal intensities on magnetic resonance angiography (MRA) correlate with the relevant hemisphere’s hemodynamics in patients with cerebrovascular diseases. We evaluated whether superficial temporal artery (STA) signal intensities (SI) on MRA were useful to evaluate the postoperative cerebral hemodynamics of patients with symptomatic internal carotid artery (ICA) or middle cerebral artery (MCA) steno-occlusive disease who underwent unilateral STA-MCA anastomosis. Twenty-one consecutive patients undergoing unilateral STA-MCA anastomosis for symptomatic ICA or MCA steno-occlusive disease were enrolled. All patients underwent MRA and superficial temporal artery duplex ultrasonography (STDU) at 3 months and 1 year postoperatively. Bilateral region of interests (ROIs) on time-of-flight (TOF)-MRA source images were placed on the STA just before its bifurcation. The STA-SI ratio, which was the ratio of the SI on the operated STA to that of the contralateral STA, was calculated; the correlation between the ratio and STDU parameters was investigated. The STA diameter and flow velocities (systolic, end-diastolic, and mean) significantly correlated with the STA-SI ratio at 1 year postoperatively (p = .0302, p = .0002, p = .0029, p = .002). The end-diastolic flow velocity ratio was significantly correlated with the STA-SI ratio at 1 year postoperatively (p = .0014, r = 0.6518). The STA-SI ratio can be used to predict the extent of postoperative collateral bypass flow, and it may help predict postoperative cerebrovascular reserve.

Clipping of a Recurrent Unruptured Middle Cerebral Artery Aneurysm with Temporary Contralateral Superficial Temporal Artery Graft Bypass: A Case Report

Clipping of a Recurrent Unruptured Middle Cerebral Artery Aneurysm with Temporary Contralateral Superficial Temporal Artery Graft Bypass: A Case Report

Досвід лікування хворих із посттравматичними артеріовенозними сполуками склепіння черепа

Objective – to improve results of treatment of patients with scalp arteriovenous malformations. Materials and methods. Results of treatment of three patients (two male 27 and 36 years old and one famale of 32 years old) with posttraumatic scalp arteriovenous malformations were analysed. The main method for verifying the diagnosis was selective cerebral angiography, Endovascular embolization and surgical resection was used in two cases, and in one case endovascular embolization was used alone. Results. In all cases the appearance of clinical manifestations was preceded by a local injury of scalp. In all patients posttraumatic malformations were localized along the midline in the projection of the intersection of sagittal and coronary sutures. The period between the onset of clinical symptoms and surgery in two cases was 3 years, in one case – 30 years. In all patients the predominant source of malformations filling was unilateral superficial temporal artery, which formed anastomosis with a contralateral superficial temporal artery, middle meningeal artery and meningeal branches of the ophtalmic artery. In two cases, malformations was an abnormally enlarged angiomatous net of small arteries without visible direct arteriovenous drainage, in one case it was direct arteriovenous shunt. In all cases the endovascular embolization of the malformations was utilized, in two cases – the surgical removal of the malformations was performed. We didn't seen any complications during the intervention. The complete occlusion of malformations with a satisfied cosmetic effect was achieved. Conclusions. Posttraumatic scalp arteriovenous malformations have heterogeneous structure. The choice of optimal management depends on the type of the malformations. In cases of direct arteriovenous shunt the method of choice should be endovascular occlusion, and in cases of angiomatous net the embolization should be supplemented by the surgical resection of the malformations.

対側浅側頭動脈からの側副血行を有する総頸動脈閉塞に対するバイパス術前後の血行動態の評価に浅側頭動脈超音波検査が有用であった一例

A 77-year-old man with a history of radiation therapy for pharyngeal cancer and consequent asymptomatic left common carotid artery (CCA) occlusion showed asymptomatic ischemic stroke and left transient monocular blindness, and he was admitted to our hospital. He was found to have an indication for bypass surgery because of a remarkable reduction in cerebral blood flow in the ipsilateral middle cerebral artery (MCA) territory. Carotid ultrasonography revealed retrograde blood flow of the ipsilateral external carotid artery (ECA) and a U-turn phenomenon to the internal carotid artery (ICA). Cerebral angiography demonstrated spontaneous bonnet bypass flow from the right superficial temporal artery (STA) to the left STA, but the blood flow via the bypass was not enough to supply the left MCA. Bypass surgery to anastomose the bonnet bypass to the left MCA was performed, and postsurgical cerebral blood flow to the ipsilateral MCA territory improved. On STA duplex ultrasonography (STDU), the pulsatility index value of the contralateral STA changed from an ECA pattern before surgery to an ICA pattern after. Moreover, postsurgical mean flow velocity of the bonnet bypass to the left MCA was relatively higher than the presurgical retrograde mean flow velocity of the left STA. These ultrasonographic findings correlated with those on single photon emission computed tomography (SPECT) and cerebral angiography. As demonstrated in the present case, ultrasonography including STDU is useful in the evaluation of cerebral hemodynamics before and after cerebral artery bypass surgery and in the usual STA-MCA anastomosis.

Three Cases of Spontaneous Superficial Temporal Artery Aneurysm with Literature Review

Spontaneous, nontraumatic, superficial temporal artery (STA) aneurysms have been rarely reported. We herewith report three cases of spontaneous and true STA aneurysms. All patients, a 65-year-old male, a 76-year-old female, and a 47-year-old female, had no history of head trauma that requires medical attention. Painless, pulsatile, and slowly growing calvarial lump was the symptom leading to image studies. All the lumps were preoperatively diagnosed as STA aneurysms by magnetic resonance angiography and/or three-dimensional computed tomographic angiography. One case was accompanied by anterior communicating aneurysm. And another case was associated with two more scalp aneurysms arising from occipital artery and contralateral STA. Pathologic studies showed that all three were true aneurysms, with intact media and adventitia but without organized hematoma. Literature review showed that 8% of all STA aneurysms comprised spontaneous STA aneurysms. We found 32 cases (19 males and 13 females) of well-described spontaneous STA aneurysms including ours. Twenty-eight cases (87.5%) were true aneurysms. Seven cases (21.9%) had coexisting vascular lesions. Five (15.6%) of these seven cases were diagnosed with cerebral or abdominal aneurysm. Multiple scalp aneurysms are quite rare; only two cases including ours have been reported. It seems important to know that spontaneous STA aneurysms may coexist with other vascular lesions including intracranial aneurysm.

STA-ACA bypass using the contralateral STA as an interposition graft for the treatment of complex ACA aneurysms: report of two cases and a review of the literature

Bypass surgery has been used as a remedy for the complex cerebral aneurysm, which was unsolved with the clipping method. However, little has been reported about bypass options for anterior cerebral artery (ACA) aneurysms. The authors experienced two patients with complex ACA aneurysms, large fusiform and large thrombosed aneurysms involving the distal A1 and proximal A2 segments, respectively. To achieve complete obliteration of the aneurysm, we performed a superficial temporal artery (STA)-ACA bypass using contralateral STA as interposition grafts with endovascular trapping without any ischemic events. These cases show that STA-ACA bypass using contralateral STA interposition graft is a feasible option to maintain blood supply to the ACA territory if a proximal ACA lesion requires trapping.

Outcome of repeat revascularization surgery for moyamoya disease after an unsuccessful indirect revascularization

Revascularization for moyamoya disease, either by direct anastomosis or indirect procedures, is an accepted and effective form of treatment for prevention of future ischemic events. Indirect procedures do not provide sufficient collateral vessels in a subset of patients, who then have persistent or new symptoms. Repeat revascularization procedures may be recommended for these patients. Sixteen patients underwent repeat revascularization after undergoing an indirect procedure in the same hemisphere. These patients were included in the study, and a retrospective review of their clinical details, neuroimaging results, surgical details, and outcome was performed. Direct revascularization was the procedure of choice; however, in patients with no acceptable recipient vessel (> 0.6 mm) the authors added a second indirect procedure for further revascularization. Over the last 19 years, 16 patients (8 male and 8 female patients, age range 5-48 years, mean 16.7 years, 10 pediatric and 6 adult patients) underwent repeat revascularization for moyamoya disease. Initially all patients presented with ischemic symptoms (4 transient ischemic attacks [TIAs] and 12 strokes; 2 patients had bilateral symptoms). Angiography revealed that 13 patients had bilateral disease, and 3 had unilateral disease. Initial surgery was bilateral encephaloduroarteriosynangiosis (EDAS) in 9, unilateral EDAS alone in 3, unilateral EDAS with contralateral superficial temporal artery-middle cerebral artery (STA-MCA) bypass in 2, bilateral encephalomyosynangiosis (EMS) in 1, and unilateral EMS in 1. Thirteen of the 16 patients continued to have TIAs in the hemisphere ipsilateral to surgery, whereas 1 patient had seizures and cognitive deficit, 1 had asymptomatic infarct on MR imaging, and 1 had visual symptoms. Poor revascularization was seen on angiography studies in all patients. The median duration between the surgeries was 24 months (3 months-10 years). Repeat revascularization was performed in 23 hemispheres (16 patients). Direct revascularization was performed in 14 hemispheres (60.9%): STA-MCA bypass in 10, external carotid artery-MCA vein bypass in 2, occipital artery (OA)-MCA in 1, and OA-posterior cerebral artery in 1 hemisphere. Indirect revascularization was performed for patients without an acceptable recipient vessel, and was done in 9 hemispheres. The procedures included EMS (4 hemispheres), repeat EDAS (2), and omental transposition (3). There was 1 postoperative death in a patient undergoing a high-flow vein graft implantation. None of the other patients experienced any neurological worsening after surgery. Follow-up was available in all patients, ranging from 3 to 144 months (mean 34 months, median 12 months). Of the 15 patients who survived repeat revascularization surgery, 12 (80%) were free from any TIA, stroke, or any other neurological symptoms. Two patients had occasional TIAs, less frequent than before, whereas 1 patient had frequent TIAs and underwent revision of the revascularization. Angiographic studies were available in 11 patients, and showed improved flow in the hemispheres in 10 patients. Follow-up MR imaging performed at 6 months did not reveal a new infarct in any patient. Repeat revascularization procedures are effective for patients who are clinically symptomatic and have inadequate collateral vessels following indirect procedures. Although direct procedures are preferred, the choice of procedure depends on the operative findings and the status of donor and recipient vessels.

Arterial Bypass Surgery Using a Spontaneously Formed “Bonnet” Superficial Temporal Artery in a Patient With Symptomatic Common Carotid Artery Occlusion

Common carotid artery (CCA) occlusive disease may cause hemodynamic cerebral ischemia resulting in the development of ischemic symptoms. The blood flow in the superficial temporal artery (STA) ipsilateral to the occluded CCA is usually poor, which limits its use as a donor artery for extracranial-intracranial arterial bypass surgery. Despite antiplatelet therapy, recurrent transient ischemic attacks manifesting as motor aphasia developed in a 72-year-old man. Neuroradiological imaging revealed misery perfusion in the bilateral cerebral hemispheres caused by left CCA occlusion and right internal carotid artery occlusion. Blood flow from the STA contralateral to the occluded CCA perfused the ipsilateral STA over the midline in a retrograde fashion. After confirming the direction and the pressure of the blood flow in the spontaneously formed "bonnet" STA, the STA was anastomosed to a cortical artery in the symptomatic frontal lobe so that blood flow in the ipsilateral STA was supplied from the contralateral STA. The procedure was accomplished without difficulty, and no further ischemic symptoms developed after surgery. Postoperative cerebral angiography demonstrated an increase in collateral flow to the anastomosed bonnet STA and perfusion to an entire territory of the upper trunk of the symptomatic middle cerebral artery via the anastomosis. This case suggests that arterial bypass surgery can be performed using a spontaneously formed bonnet STA as a donor in a patient with symptomatic CCA occlusion.

“Bonnet” Bypass to Proximal Trunk of Middle Cerebral Artery with a Radial Artery Interposition Graft: Technical Note

Anastomosis of the superficial temporal artery (STA) to the middle cerebral artery (MCA) is useful for treating certain patients with internal carotid artery occlusion or MCA occlusion. However, in the case of common carotid artery (CCA) occlusion, since the blood flow in the STA is insufficient, another artery should be used as the donor artery. The cortical branches of the MCA are usually selected as recipients in the STA-MCA bypass. However, the intracranial vascular filling gradually increases over a few months after conventional cortical MCA bypass grafting, while early or even immediate vascular filling is observed after proximal MCA bypass grafting. This study aims to develop an elongation technique of the contralateral STA to reach the proximal segment of the ipsilateral MCA. Anastomosis of the contralateral STA to the secondary trunk of the ipsilateral MCA was performed in 2 patients with occlusion of the CCA and ipsilateral vertebral artery (VA). The contralateral STA was extended with a radial artery (RA) graft in order to supply blood to the ischemic area. Elongation of the STA by using an RA interposition graft sufficiently lengthens the graft to enable its anastomosis with the contralateral M2 segment. Postoperative imaging revealed good bypass patency even at 1 year after the surgery. This novel technique of performing the "bonnet" bypass was effective in treating both CCA and ipsilateral VA occlusion; moreover, this procedure of elongation of the STA can increase candidates of the recipient, and enables one to perform a double bypass to the anterior cerebral artery (ACA) or posterior cerebral artery (PCA).

A New Approach to Retroauricular Flap Transfer

The retroauricular region provides adequate tissue of excellent color and texture match for the reconstruction of small- and medium-sized facial defects. In this study, parietal branch of the superficial temporal artery (STA) was used as the pedicle for the retroauricular island flap. Anastomoses between the parietal branch of STA, occipital artery, and contralateral STA were observed to deliver adequate nutritional blood supply to the flap. Total upper eyelid defect in 1 case, malar defect in 1 case, and forehead defects of various sizes in 4 cases were included in our study. Sizes of the flaps varied from 4 x 4.5 cm to 6 x 8 cm (mean 4.7 x 6.6 cm). All cases had venous congestion for 2-4 days (mean 3.4 days). Only 1 case experienced a superficial dermal necrosis of 1 x 3 cm in size in the distal part of the flap. Esthetic and functional results were satisfactory during the 1- to 14-month (mean 7) follow-up period. This flap is thought to be advantageous for the repair of defects and traumas of the forehead and upper eyelid as the pedicle does not develop torsion and dissection is easy.

Use of “Bonnet” Bypass with Radial Artery Interposition Graft in a Patient with Recurrent Cranial Base Carcinoma: Technical Report of Two Cases and Review of the Literature

Two patients with recurrent cranial base carcinomas involving the carotid artery received a "bonnet" bypass using the contralateral superficial temporal artery as the donor vessel because the ipsilateral common and external carotid arteries were unavailable. The radial artery was used as the graft. A 58-year-old man with ear pain and an enlarging mass involving the left cranial base and neck had undergone a right partial glossectomy and modified neck dissection followed by radiotherapy for squamous cell carcinoma. Recurrent carcinoma extensively involved the left internal carotid artery. A 46-year-old man with jaw pain and hoarseness had undergone multiple resections and radiation therapy for medullary thyroid carcinoma. Magnetic resonance imaging showed recurrent tumor on the right. Both patients underwent a pterional craniotomy. The supraclinoid internal carotid artery was exposed. The radial artery was harvested. The contralateral superficial temporal artery was dissected at its bifurcation into the frontal and parietal branches. The radial artery graft was anastomosed to the superficial temporal artery and a recipient ipsilateral branch of the middle cerebral artery. The internal carotid artery was clip-ligated. After surgery, both patients remained neurologically stable. Angiography confirmed that the bypasses were patent and that the middle cerebral artery territory filled. The patients' carcinomas were resected aggressively. When aggressive resection of cranial base tumors is needed and the ipsilateral carotid artery is unavailable as a donor vessel, a "bonnet" bypass with carotid artery sacrifice may be performed. Compared with vein grafts, microsurgical anastomosis is easier and the patency rate is higher with a radial artery graft.

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.

The Vascular Anatomy of the Galeal Flap in the Interparietal and Midline Regions

The potential extension of the galeal flap in the interparietal area was studied on 17 fresh human cadaver heads by intravascular dye injection technique. It was demonstrated that an ipsilateral superficial temporal artery that supplies the galeal flap does not cross the midline or anastomose with the contralateral superficial temporal artery but ensures the survival of a flap extended up to 1 cm proximal to the sagittal suture line. The width of the temporoparietal flap can be extended up to 15 cm, depending on the vascular pattern of the superficial temporal artery. When required, the lateral extension may provide the required soft-tissue bulk despite the reduced flap length.

The Vascular Anatomy of the Galeal Flap in the Interparietal and Midline Regions

The potential extension of the galeal flap in the interparietal area was studied on 17 fresh human cadaver heads by intravascular dye injection technique. It was demonstrated that an ipsilateral superficial temporal artery that supplies the galeal flap does not cross the midline or anastomose with the contralateral superficial temporal artery but ensures the survival of a flap extended up to 1 cm proximal to the sagittal suture line. The width of the temporoparietal flap can be extended up to 15 cm, depending on the vascular pattern of the superficial temporal artery. When required, the lateral extension may provide the required soft-tissue bulk despite the reduced flap length.