Superficial temporal artery to superior cerebellar artery bypass: how I do it

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Vertebrobasilar steno-occlusive disease and complex posterior circulation aneurysms (n=1). Intervention: Superficial temporal artery to superior cerebellar artery (STA-SCA) bypass via subtemporal approach. Primary outcome: Anastomotic patency and surgical corridor adequacy.

Q: What does this research mean for the field?

A modified subtemporal approach utilizing middle fossa floor flattening, vein of Labbé mobilization, tentorial division, and field shallowing provides an effective surgical corridor for STA-SCA bypass without requiring anterior petrosectomy. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Duy Pham; Nakao Ota; Yasuaki Okada; Rokuya Tanikawa

doi:10.1007/s00701-026-07085-x

November 7, 2026Acta NeurochirurgicaOpen Access

Superficial temporal artery to superior cerebellar artery bypass: how I do it

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Key result

Subtemporal STA-SCA bypass technique enables an adequate surgical corridor without requiring petrosectomy.

n=1

Why the study?

Superficial temporal artery to superior cerebellar artery bypass is a deep and demanding posterior circulation revascularisation procedure requiring specific technical nuances to facilitate suturing within a deep and narrow corridor.

Key Points

To describe a refined step-by-step surgical technique for performing a superficial temporal artery to superior cerebellar artery bypass via a subtemporal approach without anterior petrosectomy.
The procedure employs a subtemporal craniotomy with vertex-down head positioning and flattening of the middle fossa floor using the supramastoid crest as the inferior boundary.
Approximately 10 cm of the parietal branch of the superficial temporal artery is harvested as the donor graft.
Microsurgical dissection includes wide arachnoid release of the vein of Labbé, drainage of the ambient cistern, precise tentorial division to spare the trochlear nerve, and elevation of the recipient artery with a rubber sheet and micro-sponge.
Middle cranial fossa floor drilling combined with vertex-down positioning utilizes gravity to reduce the temporal lobe retraction force needed to reach the ambient cistern.
Visualizing the cisternal course and dural entry of the trochlear nerve before tentorial incision prevents mechanical and thermal injury to the nerve.
Lifting the recipient vessel and placing stay sutures with a bite size twice and pitch four times the wall thickness facilitates microvascular suturing within a deep, narrow corridor.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 male patient aged 55 years with bilateral cerebellar infarction from acute occlusion of the left vertebral artery and hypoplastic right vertebral artery, complicated by medullary ischemia despite optimal medical therapy.

I

Intervention

Superficial temporal artery (parietal branch) to superior cerebellar artery (lateral pontomesencephalic s2 segment) end-to-side bypass via a subtemporal craniotomy (approximately 6x6 cm) with middle fossa floor flattening, mobilisation of the vein of Labbé, tentorial division, protection of the trochlear nerve, and elevation of the recipient artery on a rubber sheet and micro-sponge.

This neurosurgical technical note details a step-by-step subtemporal approach for superficial temporal artery to superior cerebellar artery bypass that creates a workable corridor without anterior petrosectomy while minimizing brain retraction and protecting the trochlear nerve.

Limitations

Establishes a deep, narrow, horizontally oriented operative corridor that restricts microsurgical instrument working angles
Increased risk of temporal lobe contusion and venous infarction in the territory of the vein of Labbé from prolonged retraction
Continuous exposure of the slender trochlear nerve to mechanical trauma or thermal injury during tentorial incision
Steep learning curve requiring proficiency in microvascular suturing within a deep field
Deep, narrow, and horizontally oriented operative corridor that restricts working angles for microsurgical instruments
Continuous exposure of the trochlear nerve to mechanical trauma or thermal injury during tentorial incision and ambient cistern exposure
Steep learning curve requiring full proficiency in microvascular suturing within a deep field

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Implication

May facilitate subtemporal STA-SCA bypass without petrosectomy; leaves open need for comparative trials before wider adoption.

Abstract

Superficial temporal artery (STA) to superior cerebellar artery (SCA) bypass is a deep and demanding posterior circulation revascularisation procedure. We describe our step-by-step technique through a subtemporal approach, illustrated with intraoperative images and schematic drawings, emphasising flattening of the middle fossa floor, mobilisation of the vein of Labbé, tentorial division, protection of the trochlear nerve, and shallowing of the anastomotic field. Together these nuances reduce the retraction force required, protect the trochlear nerve, and facilitate suturing within a deep and narrow corridor.

Discussion

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Cite This Study

Pham et al. (2026) conducted a case report in Vertebrobasilar steno-occlusive disease and complex posterior circulation aneurysms (n=1). Superficial temporal artery to superior cerebellar artery (STA-SCA) bypass via subtemporal approach was evaluated on Anastomotic patency and surgical corridor adequacy. Subtemporal STA-SCA bypass with middle fossa floor flattening, vein of Labbé release, and SCA elevation creates a workable surgical corridor without petrosectomy.

synapsesocial.com/papers/6af1d893f9a8addd138b1c71 https://doi.org/10.1007/s00701-026-07085-x

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Superficial temporal artery to superior cerebellar artery bypass: how I do it

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Superficial temporal artery to superior cerebellar artery bypass: how I do it

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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