Strategic tunnelling of superficial temporal artery during bypass surgery for moyamoya disease.

Abstract

The superficial temporal artery to middle cerebral artery bypass remains the favoured direct technique of cerebral revascularization in moyamoya angiopathy. We describe a novel technique of tunnelling the superficial temporal artery through the temporalis muscle. The temporalis muscle is raised as a flap off the temporal bone. A triangular window is created on the temporalis fascia, and a tunnel is created for the superficial temporal artery to pass through the muscle belly. This innovative technique allows passage of the superficial temporal artery to the brain without kink or compression ensuring good bypass function and improves long-term patency.