Novel Myocutaneous Hemicraniectomy Flap: Technical Note and Cadaveric Dissection Using the “Feng-Huang Technique”

2021 ◽  
Author(s):  
Xiaochun Zhao ◽  
Dongxia Feng ◽  
Jason Huang ◽  
Yilu Zhang ◽  
Ian F. Dunn
Keyword(s):  
Present Note ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Middle Fossa ◽  
Temporalis Muscle ◽  
Novel Technique ◽  
Common Technique ◽  
Key Steps ◽  
Technical Illustration

Abstract Background: The hemicraniectomy is a common technique used in a variety of pathologies including some traumatic brain injury and malignant stroke. A novel technique of performing hemicraniectomies using a retro-auricular incision can avoid transgressing the temporalis muscle and superficial temporal artery while providing adequate hemicranial exposure. Method: This technique was reproduced in a skull base lab using a cadaveric head. The key steps of this approach were illustrated in step-by-step fashion. A post-approach CT scan of the cadaver was performed to evaluate the decompression exposure. Results: This approach is able to provide sufficient middle fossa decompression and area of exposure, while preserving the temporalis along with the superficial temporal artery. Conclusions: The altered retro-auricular flap (the “Feng-Huang” flap) is a novel technique for hemicraniectomy which can provide sufficient middle fossa decompression and exposure while sparing the temporalis muscle and superficial temporal artery during the approach. A step-by-step technical illustration is demonstrated in the present note.

Novel Hemicraniectomy Technique for Malignant Middle Cerebral Artery Infarction: Technical Note

2019 ◽  
Vol 17 (3) ◽  
pp. 273-276 ◽  
Author(s):  
Kristopher A Lyon ◽  
Nitesh P Patel ◽  
Yilu Zhang ◽  
Jason H Huang ◽  
Dongxia Feng
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Surgical Morbidity ◽  
Middle Cerebral Artery Infarction ◽  
Decompressive Hemicraniectomy ◽  
Bone Window ◽  
Large Bone

Abstract BACKGROUND AND IMPORTANCE Decompressive hemicraniectomy (DH) is the mainstay of treatment for malignant middle cerebral artery infarction (MMI). Although this operation significantly reduces mortality and improves functional outcomes, the conventional technique involves a reverse question mark incision starting anterior to the tragus that can injure the scalp's major blood supply, the superficial temporal artery (STA), which increases the risk of postoperative complications. CLINICAL PRESENTATION We developed a modified DH technique to reduce surgical morbidity associated with injury to the STA, accommodate a large bone window for effective decompression, and improve operative speed. After performing hospital chart review, a total of 34 patients were found who underwent this DH technique for MMI. Of these, 22 patients had this performed for right-sided MMI and 12 patients had this performed for left-sided MMI. CONCLUSION In each case, our approach preserved the STA and thereby minimized the risk for ischemic necrosis of the scalp flap. Since our technique avoids dissection of the preauricular temporalis muscle, we believe operative times can be decreased while still accommodating a large bone window to allow for effective decompression of the infarcted brain parenchyma.

scholarly journals Usefulness of the Lone Star Retractor System for harvesting the superficial temporal artery: technical note

2019 ◽  
pp. 1-4
Author(s):  
Koichi Torihashi ◽  
Takafumi Ogura ◽  
Tomohiro Hosoya ◽  
Sadao Nakajima ◽  
Makoto Sakamoto ◽  
...  
Keyword(s):  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Lone Star Retractor

Superficial Temporal Artery: Distal Posterior Cerebral Artery Bypass through the Subtemporal Approach: Technical Note and Pilot Surgical Cases

2017 ◽  
Vol 13 (3) ◽  
pp. 309-316 ◽  
Author(s):  
Akitsugu Kawashima ◽  
Hugo Andrade-Barazarte ◽  
Behnam Rezai Jahromi ◽  
Minna Oinas ◽  
Ahmed Elsharkawy ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Subtemporal Approach ◽  
Ischemic Complications ◽  
Proximal Occlusion

Abstract BACKGROUND: Posterior cerebral artery (PCA) aneurysms are rare and the majority are fusiform in shape. Proximal occlusion of PCA represents a treatment option for these lesions. However, this procedure carries a high risk of ischemic complications. OBJECTIVE: To describe the technique of trapping a fusiform PCA aneurysm and revascularization of the distal PCA using a superficial temporal artery (STA) graft through the same microsurgical approach. METHODS: From September 2012 to October 2014, we retrospectively identified 3 patients harboring a fusiform PCA aneurysm (P2 segment aneurysm) who underwent trapping of the aneurysm and reconstruction of the distal PCA through the same subtemporal approach. We analyzed immediate morbidity, surgical complications, and the patency of the bypass to determine the feasibility of this procedure. RESULTS: All 3 patients underwent successful trapping of the fusiform PCA aneurysm and revascularization of the distal PCA. The origin of P3 segment or posterior temporal artery (PTA) served as recipient arteries. In all 3 cases, adequate blood flow was evident after performing the STA-P3/PTA bypass. None of the patients experienced a new permanent neurological deficit. At 1-year follow-up, the STA-PTA/PCA bypasses remained patent. CONCLUSION: The STA-P3/PTA bypass through the subtemporal approach is a feasible option to maintain blood flow in cases of PCA fusiform aneurysms requiring trapping of the P2 segment.

scholarly journals Tissue Engineered Vascularized Patient-Specific Temporomandibular Joint Reconstruction in a Yucatan Pig Model

2020 ◽  
Author(s):  
Shelly Abramowicz ◽  
Sarah Jo Crotts ◽  
Scott J. Hollister ◽  
Steve Goudy
Keyword(s):  
Temporomandibular Joint ◽  
Porcine Model ◽  
Superficial Temporal Artery ◽  
Mandibular Condyle ◽  
Temporal Artery ◽  
Patient Specific ◽  
Temporalis Muscle ◽  
Control Side ◽  
Titanium Screws ◽  
3D Printed

ABSTRACTPurposePediatric temporomandibular joint (TMJ) reconstruction occurs as a result of acquired, developmental, and/or congenital conditions. Current pediatric reconstruction options are limited. The aim of this project was to develop a proof of principle porcine model for a load bearing, customized 3-dimensional (3D) printed and BMP2-coated scaffold implanted in a pedicled (temporal) flap as a regenerative approach to pediatric TMJ mandibular condyle reconstruction.Materials and MethodsScaffolds were custom designed and 3D printed based on porcine computed tomography and absorbed with BMP2. Two operations occured: (1) implantation of scaffold in temporalis muscle to establish vascularity, and six weeks later, (2) unilateral condylectomy and rotation of the vascularized scaffold (with preservation of superficial temporal artery) onto mandibular ramus defect and secured with titanium screws. At 6 months post-implantation, the pigs were sacrified. The experimental side (muscle-scaffold) and the control side (unoperated condyle) were individually harvested at 6 months and evaluated by clinical, mechanical, radiographic, and qualitative/histologic methods.ResultsScaffolds maintained physical properties similar in appearance to unoperated condyles. The vascularized scaffolds had bone formation at edges and adjacent to scaffold-bone interface. New bone was visible in scaffold. Condyle height on the reconstructed side was 68% and 78% of the control side. Reconstructed condyle stiffness was between 20% and 45% of the control side.ConclusionIn our porcine model, customized 3D printed TMJ scaffolds impregnanted with BMP2 and implanted in and pedicled on temporalis muscle has the ability to (1) reconstruct a TMJ defect model, (2) maintain appropriate condylar height and upper airway diameter, and (3) generate new bone, without impacting functional outcomes.

Superficial Temporal Artery Dissection: A Technical Note

2012 ◽  
Vol 72 (1) ◽  
pp. ons6-ons8 ◽  
Author(s):  
Clemens M. Schirmer ◽  
Carlos A. David
Keyword(s):  
Computed Tomography ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Artery Dissection ◽  
Ultrasound Probe ◽  
Bypass Procedure ◽  
Temporal Fascia ◽  
Wound Breakdown ◽  
Superficial Wound

Abstract Background: Dissection of the superficial temporal artery (STA) is often required in preparation for a bypass procedure. Traditionally, dissection of the STA involves a direct cutdown on the artery after marking the course of the artery on the skin with the help of a Doppler ultrasound probe. Objective: We describe a method that takes advantage of the position of the STA superficial to the temporal fascia. Methods: The technique was used in a total of 38 procedures in 32 patients to create synangiosis or extracranial-intracranial STA bypasses. The STA was dissected using a blunt malleable brain retractor that was inserted into the subgaleal plane directly over the STA, allowing creation of a linear incision and concurrent protection of the STA in its bed. Either computed tomography- or catheter-based angiography was used to evaluate the patency postoperatively. Results: All STA vessels were dissected without complications or injury to the graft vessel. The sole complication was a superficial wound breakdown in a synangiosis case. Postoperative angiography demonstrated patency in all but 1 of the 24 bypass cases (95.8%). Conclusion: We describe a method that takes advantage of the position of the STA superficial to the temporal fascia to allow rapid, safe, and efficacious dissection. The incision is linear and easier to manage and close. In our series, there were no technical complications related to the dissection of the STA.

scholarly journals In Reply: Superficial Temporal Artery: Distal Posterior Cerebral Artery Bypass Through the Subtemporal Approach: Technical Note and Pilot Surgical Cases

2018 ◽  
Vol 15 (4) ◽  
pp. 48-49
Author(s):  
Akitsugu Kawashima ◽  
Hugo Andrade-Barazarte ◽  
Behnam Rezai Jahromi ◽  
Takakazu Kawamata ◽  
Juha A Hernesniemi
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Technical Note ◽  
Subtemporal Approach
Sign in / Sign up

Export Citation Format

Share Document