The anterior temporal artery: a versatile donor for revascularization of complex middle cerebral artery aneurysms

Complex middle cerebral artery (MCA) aneurysms pose a significant challenge despite the advancements in interventional materials and microsurgical techniques. A subset of these aneurysms may benefit from surgical revascularization. Identifying a safe and effective intracranial donor artery as another alternative is critical for managing these aneurysms. In this study, the authors evaluate the feasibility, safety, and efficacy in using the anterior temporal artery (ATA) in revascularizing a consecutive series of complex MCA aneurysms.

Data from patients managed with a bypass structure consisting of the ATA as a donor from January 2010 to June 2023 were obtained from an institutional review board-approved, prospectively maintained database with informed consent from the patients. Bypass patency and aneurysm occlusion were evaluated at discharge, 6 months postoperatively, and then annually or whenever the patient had a neurological symptom.

In 9 patients, bypasses were performed with the ATA for 9 complex MCA aneurysms. All cases attained bypass patency, and no ischemic events occurred during the bypass procedures. The bypass type was classified as a combination bypass in 7 patients and a simple in situ bypass in 2 patients. The most frequently used techniques involving the ATA were side-to-side in situ bypass (6 times in 6 patients) and end-to-side reimplantation (7 times in 4 patients). The mean follow-up period was 40.78 months (range 18-60 months), with an improved or unchanged modified Rankin Scale score in 8 patients at the final follow-up.

The ATA is a safe and versatile donor for intracranial-intracranial revascularization in managing complex MCA aneurysms. However, due to the diversity of angioarchitecture in complex MCA aneurysms, bypass reconstructions with the ATA should be tailored to each case according to the specific characteristics of the vascular anatomy and hemodynamics.