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Development of the superficial temporal artery in pediatric patients: considerations for surgical revascularization
Allison S Liang1, Samuel A Tenhoeve1,2, Michael T Bounajem1
11Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City.
Insights
Superficial temporal artery (STA) growth is most rapid in the first three years of life, with significant increases in diameter. Understanding STA growth patterns is crucial for planning bypass surgeries in pediatric patients with vascular conditions.
Area of Science:
- Vascular Surgery
- Pediatric Neurology
- Cranial Arteriopathy
Background:
- Superficial temporal artery (STA) size is critical for pediatric moyamoya disease and arteriopathy patients needing intracranial perfusion augmentation.
- STA-to-middle cerebral artery bypass is a key procedure, making STA lumen diameter essential for success.
Purpose of the Study:
- To characterize the growth of the superficial temporal artery (STA) from infancy to adulthood.
- To provide data for operative planning in pediatric patients requiring STA bypass.
Main Methods:
- Retrospective analysis of 60 patients across six age groups (0-3 years to >18 years).
- Computed tomography angiography (CTA) of the head was used to measure STA diameters at multiple branches.
- Statistical analysis included ANOVA and logistic growth modeling for infants.
Main Results:
- STA diameters showed significant growth, particularly between 0-3 years old.
- Peak growth rates during infancy were 33.6% (main branch), 21.9% (frontal), and 31.0% (parietal) annually.
- Children aged 0-3 years had significantly smaller STA diameters compared to all other age groups (p < 0.001).
Conclusions:
- Superficial temporal artery (STA) maturation primarily occurs within the first three years of life.
- Knowledge of STA growth patterns aids surgical planning for pediatric vascular pathologies requiring bypass procedures.
Objective:
The size of the superficial temporal artery (STA) is a key consideration for pediatric patients with moyamoya disease or arteriopathies requiring intracranial perfusion augmentation. For selected patients, STA-to-middle cerebral artery bypass is considered. Because STA lumen diameter is critical to the success of this procedure, the authors aimed to characterize STA growth from infancy to adulthood.
Methods:
This single-institution retrospective analysis included patients in 6 age groups (0-3 years old, 4-7 years old, 8-11 years old, 12-15 years old, 16-18 years old, and > 18 years old) without disease or trauma that could affect STA morphology who underwent computed tomography angiography of the head. The diameters of the left and right STAs were measured at the main branch at the level of the zygoma and at the frontal and parietal branches at the level of the orbit. Differences were assessed via 1-way analysis of variance and post hoc analyses. In a subanalysis, the STA lumen diameters of the 0- to 3-year-old patients were modeled via a logistic growth model.
Results:
A total of 10 patients were included in each age category, resulting in 120 STAs from 60 patients. The mean ± SD main branch STA diameters by age were 2.0 ± 0.47, 2.6 ± 0.44, 2.4 ± 0.37, 2.5 ± 0.30, 2.4 ± 0.28, and 2.6 ± 0.33 mm. The mean frontal branch diameters were 1.6 ± 0.55, 2.2 ± 0.51, 2.3 ± 0.39, 2.2 ± 0.20, 2.4 ± 0.28, and 2.3 ± 0.39 mm, and the mean parietal branch diameters were 1.5 ± 0.54, 2.2 ± 0.45, 2.1 ± 0.45, 2.3 ± 0.46, 2.1 ± 0.43, and 2.1 ± 0.30 mm by age group. Children aged 0-3 years had significantly smaller diameters compared with all other age groups (p < 0.001). During peak STA growth (0-3 years), the main, frontal, and parietal STA growth rates were 33.6%, 21.9%, and 31.0% per year, respectively.
Conclusions:
STA maturation mostly occurs in the first 3 years of life. STA growth patterns can assist with operative planning for pediatric patients with vascular pathologies requiring direct bypass.
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