Surgical Anatomy of the Donor Arteries for Extracranial-Intracranial Bypass Surgery: An Anatomic and Radiologic Study

Objective: To review the microsurgical anatomy of the donor arteries for extracranial-intracranial bypass, namely, the superficial temporal artery (STA), occipital artery (OA), and internal maxillary artery (IMA). Methods: Seven cadaveric specimens were dissected to identify the relationships between each artery and its surrounding structures. Nineteen computed tomographic angiographic images of Japanese adult patients (38 sides) were analyzed to examine the course of each artery and to measure the diameters and distances from various anatomic landmarks to each artery. Results: The courses of the STA, OA, and IMA, which must be exposed during revascularization procedures, were shown via cadaver dissection with special reference to the following relationships to surrounding structures: STA, soft tissue layers of the temporoparietal region and facial nerve; OA, suboccipital muscles; and IMA, mandibular nerve. In addition, we measured the diameter of the anastomotic site for each artery and its relationship with surrounding muscles. Conclusions: A precise understanding of the anatomic characteristics of the donor arteries and their relationships with surrounding structures provides safe access to these arteries.