The Middle Temporal Artery: Surgical Anatomy and Exposure for Cerebral Revascularization

BACKGROUND: The middle temporal artery (MTA) is the proximal medial branch of the superficial temporal artery (STA), supplying the temporalis muscle along with deep temporal arteries. Its use in vascularized flaps for reconstructive and otologic procedures has been described, yet its potential use in neurosurgery has not been studied. We report a novel technique for exposing the MTA and evaluated its characteristics for extracranial-eintracranial cerebrovascular bypass. METHODS: After a curvilinear frontotemporal incision in 10 cadaveric specimens, the STA was dissected from distal to proximal. The horizontal portion of MTA was found posterolateral to the posterior end of the zygomatic root and was followed proximally until its origin and distally until its 2 terminal branches. The total length, visible branches, and caliber of MTA were measured. RESULTS: The mean total harvested length of MTA was 31.7 +/- 5.1 mm, with an average proximal caliber of 1.7 +/- 0.4 mm, and distal caliber of 1.3 +/- 0.5 mm. There were 4-6 terminal MTA branches. The caliber of the proximal STA trunk was 2.5 +/- 0.5 mm. The origin of the MTA was visible with a mean distance of 16.9 +/- 4.8 mm inferior to the PEZR. The parotid gland was traversed and a communicating auriculotemporal nerve to the temporal branch of the facial nerve crossed MTA in 2 specimens. CONCLUSIONS: MTA can be safely harvested with an anterolateral approach, following its horizontal portion at the level of the zygomatic root, which is constant. The length and caliber of MTA makes it a potential alternative donor vessel or interposition graft for extracranial-intracranial bypass, especially when other donors are unavailable.