Development of the superficial temporal artery in pediatric patients: considerations for surgical revascularization.

OBJECTIVE

The size of the superficial temporal artery (STA) is a key consideration for pediatric patients with moyamoya disease or arteriopathies requiring intracranial perfusion augmentation. For selected patients, STA-to-middle cerebral artery bypass is considered. Because STA lumen diameter is critical to the success of this procedure, the authors aimed to characterize STA growth from infancy to adulthood.

METHODS

This single-institution retrospective analysis included patients in 6 age groups (0-3 years old, 4-7 years old, 8-11 years old, 12-15 years old, 16-18 years old, and > 18 years old) without disease or trauma that could affect STA morphology who underwent computed tomography angiography of the head. The diameters of the left and right STAs were measured at the main branch at the level of the zygoma and at the frontal and parietal branches at the level of the orbit. Differences were assessed via 1-way analysis of variance and post hoc analyses. In a subanalysis, the STA lumen diameters of the 0- to 3-year-old patients were modeled via a logistic growth model.

RESULTS

A total of 10 patients were included in each age category, resulting in 120 STAs from 60 patients. The mean ± SD main branch STA diameters by age were 2.0 ± 0.47, 2.6 ± 0.44, 2.4 ± 0.37, 2.5 ± 0.30, 2.4 ± 0.28, and 2.6 ± 0.33 mm. The mean frontal branch diameters were 1.6 ± 0.55, 2.2 ± 0.51, 2.3 ± 0.39, 2.2 ± 0.20, 2.4 ± 0.28, and 2.3 ± 0.39 mm, and the mean parietal branch diameters were 1.5 ± 0.54, 2.2 ± 0.45, 2.1 ± 0.45, 2.3 ± 0.46, 2.1 ± 0.43, and 2.1 ± 0.30 mm by age group. Children aged 0-3 years had significantly smaller diameters compared with all other age groups (p < 0.001). During peak STA growth (0-3 years), the main, frontal, and parietal STA growth rates were 33.6%, 21.9%, and 31.0% per year, respectively.

CONCLUSIONS

STA maturation mostly occurs in the first 3 years of life. STA growth patterns can assist with operative planning for pediatric patients with vascular pathologies requiring direct bypass.