Preoperative detailed evaluation intracranial artery stenosis using three-dimensional visualization analysis reduces the invasiveness of superficial temporal artery-middle cerebral artery bypass

OBJECTIVES: Superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery is a common treatment for preventing cerebral ischemia in patients with intracranial artery stenosis. The aim of this study was to analyze the surgical outcomes of the STA-MCA bypass procedure, particularly with regard to the invasiveness of targeted bypass (TB) with preoperative planning using Amira(®) software. METHODS: Consecutive patients with single STA-MCA bypass performed by a single neurosurgeon from January 2019 to May 2022 were included. The clinical parameters of seven TB patients were compared with those of 11 patients treated with the conventional method (CM). RESULTS: Compared with CM patients, TB using Amira(®) software patients had a shorter scalp incision (median [interquartile range]=11.2 [9.7–12.7] cm vs. 16.9 [16.0–17.7] cm, respectively; p=0.004], smaller craniotomy size (11.8 [11.5–14.4] cm(2) vs. 20.9 [17.1–22.2] cm(2), respectively; p=0.01], shorter surgery duration (201 [195–218] min vs. 277 [229–310] min, respectively; p=0.003], and less intraoperative bleeding (10 [10–20] g vs. 23 [20–50] g, respectively; p=0.033]. However, there were no differences in surgical complications between the two groups. CONCLUSIONS: Detailed preoperative evaluation using Amira(®) software can reduce the invasiveness of the STA-MCA bypass procedure.