Minimally Invasive Double-Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass

Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass is used to augment flow in various cases. We present a patient with a refractory right MCA transient ischemic attack and a minor stroke. He was perfusion dependent. A computed tomography perfusion with acetazolamide challenge showed hypoperfusion in the superior and inferior trunk of the MCA on the right side. We thus used the frontal and parietal branches of the STA to revascularize both territories. This was done via a small single incision and craniotomy. We present here the details of the techniques and surgical nuances (Video 1). The patient consented to the procedure and to the publication of his or her own images.