Skip to main content

Advertisement

SpringerLink
Log in

Superficial temporal artery lengthening technique to prevent postoperative wound complications in direct revascularization to the anterior cerebral artery for Moyamoya disease

  • Technical Note - Vascular Neurosurgery - Other
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Neurocognitive dysfunctions or psychomotor symptoms of Moyamoya disease may improve after direct revascularization to the anterior cerebral artery (ACA). However, long-distance harvest of the frontal branch of the superficial temporal artery (STA) is needed to reach the cortical ACA, frequently resulting in postoperative wound complications. To solve this problem, we devised a novel method (STA lengthening technique). In this study, we compared the STA lengthening technique and the conventional method regarding postoperative wound complications.

Methods

Twenty-five patients who underwent STA-ACA direct bypass from December 2016 to October 2021 were retrospectively reviewed, and postoperative wound complications were recorded. Magnetic resonance angiography was performed to evaluate the patency of the bypass to the ACA and postoperative development of collaterals to the skin flap.

Results

Thirty-eight hemispheres (new method [n = 12] vs. conventional method [n = 26]) were treated. Wound complications occurred in 12 surgeries (46%) of the conventional method, and none (0%) of the new method. The anastomosis with the cortical ACA was patent in all surgeries. Postoperative development of collaterals to the skin flap was confirmed after all surgeries (100%) in the new method, whereas after only five surgeries (20%) in the conventional method.

Conclusion

The STA lengthening technique can enable to preserve the collateral circulation to the skin flap postoperatively, resulting in good wound healing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Data availability

The submission does not include details (names, dates of birth, identity numbers, biometrical characteristics [such as facial features, fingerprint, writing style, voice pattern, DNA, or other distinguishing characteristics], and other information) of the participants’ information and images that may identify the person. The identity of the patients has been protected. The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Acker G, Fekonja L, Vajkoczy P (2018) Surgical management of Moyamoya disease. Stroke 49(2):476–482

    Article  Google Scholar 

  2. Acker G, Schlinkmann N, Fekonja L, Grünwald L, Hardt J, Czabanka M, Vajkoczy P (2019) Wound healing complications after revascularization for moyamoya vasculopathy with reference to different skin incisions. Neurosurg Focus 46(2):E12

    Article  Google Scholar 

  3. Araki Y, Uda K, Yokoyama K et al (2020) Surgical designs of revascularization for moyamoya disease: 15 years of experience in a single center. World Neurosurgery 139:e325–e334

    Article  Google Scholar 

  4. Baba T, Houkin K, Kuroda S (2008) Novel epidemiological features of moyamoya disease. J Neurol Neurosurg Psychiatry 79(8):900–904

    Article  CAS  Google Scholar 

  5. Calviere L, Catalaa I, Marlats F, Januel A-C, Lagarrigue J, Larrue V (2011) Improvement in cognitive function and cerebral perfusion after bur hole surgery in an adult with moyamoya disease: Case report. J Neurosurg 115(2):347–349

    Article  Google Scholar 

  6. Calviere L, Catalaa I, Marlats F, Viguier A, Bonneville F, Cognard C, Larrue V (2010) Correlation between cognitive impairment and cerebral hemodynamic disturbances on perfusion magnetic resonance imaging in European adults with moyamoya disease: Clinical article. J Neurosurg 113(4):753–759

    Article  Google Scholar 

  7. Chung Y, Lee SH, Choi SK (2017) Fundamental basis of scalp layering techniques to protect against wound infection: a comparative study between conventional and in-to-out dissection of the superficial temporal artery. World Neurosurgery 97:304–311

    Article  Google Scholar 

  8. Deng X, Gao F, Zhang D et al (2017) Effects of different surgical modalities on the clinical outcome of patients with moyamoya disease: a prospective cohort study. J Neurosurg 128(5):1327–1337

    Article  Google Scholar 

  9. Deng X, Gao F, Zhang D et al (2017) Direct versus indirect bypasses for adult ischemic-type moyamoya disease: a propensity score–matched analysis. J Neurosurg 128(6):1785–1791

    Article  Google Scholar 

  10. Fujimura M, Tominaga T (2015) Diagnosis of moyamoya disease: international standard and regional differences. Neurol Med Chir. https://doi.org/10.2176/nmc.ra.2014-0307

    Article  Google Scholar 

  11. Horiuchi T, Ichinose S, Agata M, Ito K, Hongo K (2018) STA-ACA bypass using the ipsilateral free STA graft as an interposition graft and A3–A3 anastomosis for treatment of bilateral ACA steno-occlusive ischemia. Acta Neurochir 160(4):779–782

    Article  Google Scholar 

  12. Houkin K, Kamiyama H, Abe H, Takahashi A, Kuroda S (1996) Surgical Therapy for adult moyamoya disease. Stroke 27(8):1342–1346

    Article  CAS  Google Scholar 

  13. Ishii R, Koike T, Takeuchi S, Ohsugi S, Tanaka R, Konno K (1983) Anastomosis of the superficial temporal artery to the distal anterior cerebral artery with interposed cephalic vein graft: Case report. J Neurosurg 58(3):425–429

    Article  CAS  Google Scholar 

  14. Ishikawa T, Kamiyama H, Kuroda S, Yasuda H, Nakayama N, Takizawa K (2006) Simultaneous superficial temporal artery to middle cerebral or anterior cerebral artery bypass with pan-synangiosis for moyamoya disease covering both anterior and middle cerebral artery territories. Neurol Med Chir 46(9):462–468

    Article  Google Scholar 

  15. Iwama T, Hashimoto N, Miyake H, Yonekawa Y (1998) Direct revascularization to the anterior cerebral artery territory in patients with moyamoya disease: report of five cases. Neurosurgery 42(5):1157–1161

    Article  CAS  Google Scholar 

  16. Iwata Y, Mizuta T, Takemoto O, Shimizu K, Nakatani S (1988) An interposed superficial temporal artery graft bypass for anterior cerebral artery ischemia. Microsurgery 9(1):14–17

    Article  CAS  Google Scholar 

  17. Jeon JP, Kim JE, Cho W-S, Bang JS, Son Y-J, Oh CW (2017) Meta-analysis of the surgical outcomes of symptomatic moyamoya disease in adults. J Neurosurg 128(3):793–799

    Article  Google Scholar 

  18. Karzmark P, Zeifert PD, Tan S, Dorfman LJ, Bell-Stephens TE, Steinberg GK (2008) Effect of moyamoya disease on neuropsychological functioning in adults. Neurosurgery 62(5):1048–1052

    Article  Google Scholar 

  19. Katsuta T, Inoue T, Arakawa S, Uda K (2001) Cutaneous necrosis after superficial temporal artery-to-middle cerebral artery anastomosis: is it predictable or avoidable? Neurosurgery 49(4):879–884

    CAS  PubMed  Google Scholar 

  20. Kim H, Jang D-K, Han Y-M et al (2016) Direct bypass versus indirect bypass in adult moyamoya angiopathy with symptoms or hemodynamic instability: a meta-analysis of comparative studies. World Neurosurgery 94:273–284

    Article  Google Scholar 

  21. Kim JE, Oh CW, Kwon O-K, Park SQ, Kim SE, Kim YK (2008) Transient hyperperfusion after superficial temporal artery/middle cerebral artery bypass surgery as a possible cause of postoperative transient neurological deterioration. CED 25(6):580–586

    Google Scholar 

  22. Kiyofuji S, Inoue T, Hasegawa H, Tamura A, Saito I (2014) A3–A3 anastomosis and superficial temporal artery-radial artery graft-A3 bypass to treat bilateral ACA steno-occlusive hemodynamic ischemia with cognitive and executive dysfunction: a technical note. Acta Neurochir 156(11):2085–2093

    Article  Google Scholar 

  23. Kuroda S (2021) Moyamoya disease: current knowledge and future perspectives. Springer Nature

  24. Lohasammakul S, Turbpaiboon C, Chompoopong S, Ratanalekha R, Aojanepong C (2017) Vascular nature and existence of anastomoses of extrinsic postauricular fascia: application for staged auricular reconstruction. Ann Plast Surg 78(6):723–727

    Article  CAS  Google Scholar 

  25. Mizoi K, Kayama T, Yoshimoto T, Nagamine Y (1996) Indirect revascularization for moyamoya disease: is there a beneficial effect for adult patients. Surg Neurol 45(6):541–8; discussion 548–9

  26. Nakagawa A, Fujimura M, Arafune T, Sakuma I, Tominaga T (2009) Clinical implications of intraoperative infrared brain surface monitoring during superficial temporal artery–middle cerebral artery anastomosis in patients with moyamoya disease: Clinical article. J Neurosurg 111(6):1158–1164

    Article  Google Scholar 

  27. Nakamizo A, Amano T, Michiwaki Y, Kawano Y, Kuwashiro T, Yasaka M, Okada Y (2018) Long-term neurocognitive outcomes in patients with adult moyamoya disease. World Neurosurgery 119:e441–e448

    Article  Google Scholar 

  28. Pinar YA, Govsa F (2006) Anatomy of the superficial temporal artery and its branches: its importance for surgery. Surg Radiol Anat 28(3):248–253

    Article  Google Scholar 

  29. Suzuki J, Kodama N (1983) Moyamoya disease–a review. Stroke 14(1):104–109

    Article  CAS  Google Scholar 

  30. Suzuki J, Takaku A (1969) Cerebrovascular “moyamoya” disease: disease showing abnormal net-like vessels in base of brain. Arch Neurol 20(3):288–299

    Article  CAS  Google Scholar 

  31. Takagi Y, Miyamoto S, Group C-JS (2015) Cognitive dysfunction survey of the japanese patients with moyamoya disease (COSMO-JAPAN study): study protocol. Neurologia medico-chirurgica. https://doi.org/10.2176/nmc.ra.2014-0326

  32. Takanari K, Araki Y, Okamoto S et al (2015) Operative wound-related complications after cranial revascularization surgeries. J Neurosurg 123(5):1145–1150

    Article  Google Scholar 

  33. Teo M, Johnson J, Steinberg GK (2017) Strategies for and outcome of repeat revascularization surgery for moyamoya disease: an American institutional series. Neurosurgery 81(5):852–859

    Article  Google Scholar 

  34. Tominaga T, Suzuki N, Miyamoto S, Koizumi A, Kuroda S, Takahashi JC, Fujimura M, Houkin K (2018) Recommendations for the management of moyamoya disease: a statement from research committee on spontaneous occlusion of the circle of Willis (moyamoya disease) [2nd Edition]. Surgery for Cerebral Stroke 46(1):1–24

    Article  Google Scholar 

  35. Whetzel TP, Mathes SJ (1992) Arterial anatomy of the face: an analysis of vascular territories and perforating cutaneous vessels. Plast Reconstr Surg 89(4):591–603; discussion 604–5

  36. Yoshimura S, Egashira Y, Enomoto Y, Yamada K, Yano H, Iwama T (2010) Superficial temporal artery to middle cerebral artery double bypass via a small craniotomy. Neurol Med Chir 50(10):956–959

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, NTT Medical Center Tokyo, 5-9-22, Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan

    Sho Tsunoda, Tomohiro Inoue, Masafumi Segawa, Mariko Kawashima & Atsuya Akabane

  2. Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Nobuhito Saito

Authors
  1. Sho Tsunoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tomohiro Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masafumi Segawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mariko Kawashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsuya Akabane
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nobuhito Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: [Sho Tsunoda], [Tomohiro Inoue]; methodology: [Sho Tsunoda], [Tomohiro Inoue]; formal analysis and investigation: [Sho Tsunoda]; writing—original draft preparation: [Sho Tsunoda]; writing—review and editing: [Masafumi Segawa], [Tomohiro Inoue], [Mariko Kawashima]; funding acquisition: [not applicable]; resources: [null]; supervision: [Tomohiro Inoue], [Atsuya Akabane], [Nobuhito Saito].

Corresponding author

Correspondence to Sho Tsunoda.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of NTT Medical Center Tokyo (approval number: 21–114) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Verbal informed consent was obtained from all participants, and the authors.

Consent for publication

The participants consented to the submission of this study to the journal.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Vascular Neurosurgery - Other

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 525 MB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsunoda, S., Inoue, T., Segawa, M. et al. Superficial temporal artery lengthening technique to prevent postoperative wound complications in direct revascularization to the anterior cerebral artery for Moyamoya disease. Acta Neurochir 164, 1845–1854 (2022). https://doi.org/10.1007/s00701-022-05180-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-022-05180-3

Keywords

Search

Navigation