Superficial temporal artery to middle cerebral artery bypass complications

Superficial temporal artery to middle cerebral artery bypass complications and undesired results have been described following this procedure but most can be avoided with attention to technical details. Some of these unwanted outcomes include graft occlusion, subgaleal hematoma, scalp necrosis, and postoperative intracranial hemorrhage.

It is important to have a technically perfect anastomosis with no damage during dissection of the donor or recipient artery to achieve short- and long-term patency of the graft. It is also equally important to avoid kinking or pressure by the bone edges from inadequate bone removal during closure to prevent graft compromise. If resistive flow is occurring during closure, certain maneuvers can be useful but they will not overcome the effect of a poor technical anastomosis. Maneuvers to salvage flow include maintenance of adequate blood pressure (above 110 mm Hg systolic), irrigation with warm, not cold, saline with dilute papaverine, and administration of 500 cc of dextran 40 to decrease platelet function.

Prevention of scalp problems can be achieved by limited lateral dissection of the STA, adequate hemostasis, and postoperative subgaleal drain. Limited cortical dissection and preservation of veins is helpful to prevent intracranial hemorrhage.