Virtual surgical planning for superficial temporal artery to middle cerebral artery bypass using three-dimensional digital subtraction angiography.

Objective: To introduce reliable and minimally invasive virtual surgical planning for superficial temporal artery to middle cerebral artery (STA-MCA) bypass surgery using three-dimensional (3-D) rotational reconstruction digital subtraction angiography (DSA).

Methods: Twenty-eight consecutive patients (11 women and 17 men) with cerebrovascular insufficiency due to internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion (n = 16), ICA or MCA stenosis (n = 6), and moyamoya or moyamoya-like disease (n = 6) underwent rotational DSA. Anatomical locations of the appropriate donor branch of the STA, the most suitable recipient of MCA and squamous sutures on the skull surface, were visualized using 3-D reconstruction imaging. Localization of the minicraniotomy, the skin incision on top of the superficial temporal artery branch, and the anastomosis point were accurately determined by virtual surgical planning.

Results: According to preoperative assessments, the minimum necessary skin incision and small craniotomy were successfully achieved. The preselected artery was found without additional craniotomy and anastomosed at the putative point in all patients. Perioperative complications did not arise and all bypasses remained patent on follow-up.

Conclusion: Preoperative 3-D virtual surgical planning assessments are exactly consistent with operative findings. Such assessments avoid unnecessary manipulation and simplify the surgical procedure. This imaging technique is helpful for planning STA-MCA bypass surgery.