Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Skull Base and Cerebrovascular Laboratory, University of California, San Francisco.
Oper Neurosurg (Hagerstown). 2019 Mar 1;16(3):335-344. doi: 10.1093/ons/opy115.
Intracranial-intracranial and extracranial-intracranial bypass options for revascularization of deep cerebral recipients are limited and technically demanding.
To assess the anatomical feasibility of using the temporopolar artery (TPA) for revascularization of the anterior cerebral artery (ACA), posterior cerebral artery (PCA), and superior cerebellar arteries (SCA).
Orbitozygomatic craniotomy was performed bilaterally on 8 cadaveric heads. The cisternal segment of the TPA was dissected. The TPA was cut at M3-M4 junction with its proximal and distal calibers and the length of the cisternal segment measured. Feasibility of the TPA-A1-ACA, TPA-A2-ACA, TPA-SCA, and TPA-PCA bypasses were assessed.
A total of 17 TPAs were identified in 16 specimens. The average distal TPA caliber was 1.0 ± 0.2 mm, and the average cisternal length was 37.5 ± 9.4 mm. TPA caliber was ≥ 1.0 mm in 12 specimens (70%). The TPA-A1-ACA bypass was feasible in all specimens, whereas the TPA reached the A2-ACA, SCA, and PCA in 94% of specimens (16/17). At the point of anastomosis, the average recipient caliber was 2.5 ± 0.5 mm for A1-ACA, and 2.3 ± 0.7 mm for A2-ACA. The calibers of the SCA and PCA at the anastomosis points were 2.0 ± 0.6 mm, and 2.7 ± 0.8 mm, respectively.
The TPA-ACA, TPA-PCA, and TPA-SCA bypasses are anatomically feasible and may be used when the distal caliber of the TPA stump is optimal to provide adequate blood flow. This study lays foundations for clinical use of the TPA for ACA revascularization in well-selected cases.
颅内-颅内和颅外-颅内旁路选择用于脑深部受体的再血管化是有限的，并且技术要求高。
评估使用颞极动脉（TPA）进行大脑前动脉（ACA）、大脑后动脉（PCA）和小脑上动脉（SCA）再血管化的解剖可行性。
对 8 个尸体头颅进行双侧眶颧开颅术。对 TPA 的池段进行解剖。在 M3-M4 交界处将 TPA 切断，测量其近端和远端口径以及池段的长度。评估 TPA-A1-ACA、TPA-A2-ACA、TPA-SCA 和 TPA-PCA 旁路的可行性。
在 16 个标本中总共发现了 17 个 TPA。远端 TPA 口径的平均直径为 1.0±0.2mm，池段的平均长度为 37.5±9.4mm。12 个标本（70%）的 TPA 口径≥1.0mm。TPA-A1-ACA 旁路在所有标本中均可行，而 TPA 到达 A2-ACA、SCA 和 PCA 的比例为 94%（16/17）。在吻合点，A1-ACA 的平均受体口径为 2.5±0.5mm，A2-ACA 为 2.3±0.7mm。吻合点 SCA 和 PCA 的口径分别为 2.0±0.6mm 和 2.7±0.8mm。
TPA-ACA、TPA-PCA 和 TPA-SCA 旁路在解剖上是可行的，当 TPA 残端的远端口径最佳时，可以提供足够的血流。本研究为在精心选择的病例中临床使用 TPA 进行 ACA 再血管化奠定了基础。
