A neuronavigation-based method for locating the superficial temporal artery during extra-intracranial bypass surgery

Area of Science:

• Neurosurgery
• Vascular Surgery
• Medical Imaging

Background:

• The superficial temporal artery (STA) is a common donor vessel for extracranial to intracranial bypass surgery.
• Current methods using Doppler probes to locate the STA can be time-consuming and challenging, especially with tortuous arterial paths.

Purpose of the Study:

• To evaluate an alternative neuronavigation-based technique for precise STA localization prior to surgery.
• To compare the accuracy of neuronavigation with conventional Doppler methods and intraoperative findings.

Main Methods:

• Preoperative CT angiography (CTA) or magnetic resonance angiography (MRA) was used to delineate STA outlines.
• STA outlines were projected and traced onto the skin for neuronavigation guidance.
• The technique was applied in eight STA dissections, with comparisons to Doppler and intraoperative vessel courses.

Main Results:

• The neuronavigation-based STA trajectory accurately predicted the vessel's intraoperative position in all cases.
• Preoperative imaging included CTA, 3D contrast-enhanced T1-weighted MRA, and/or 3D time-of-flight MRA.
• Neuronavigation findings were consistently confirmed by Doppler probe before skin incision.

Conclusions:

• Neuronavigation using preoperative CTA or MRA is a valid and accurate method for identifying STA trajectory in bypass surgery.
• This technique offers an improvement over traditional Doppler localization, particularly for complex arterial anatomy.
• Careful preoperative analysis of the STA from its origin is crucial to avoid misidentification of adjacent venous structures.