Technical NoteOccipital Artery to Middle Cerebral Artery Bypass: Operative Nuances

BackgroundSuperficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis is a common procedure for vascular neurosurgeons, and it is used in a variety of diseases. However, there are cases in which the STA is absent or is too hypoplastic to be used as a donor for revascularization. Occipital artery (OA)-MCA bypass may be a treatment option in these cases.MethodsWe encountered 4 cases of symptomatic cerebral ischemia in which the STA was absent or unavailable. These cases were treated by revascularization from the OA to the periphery of the MCA.ResultsBy meticulous dissection of the OA to the level of the superior temporal line, the OA could reach the periphery of the angular artery and be anastomosed to it in the usual fashion. The patency of the donor artery was confirmed by magnetic resonance angiography soon after the operation and 3 years later.ConclusionsOA-MCA bypass may be a surgical option for cerebral revascularization when the STA is not available.