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The anatomy of the superficial temporal artery was investigated in radiographic and cadaveric studies. The superficial temporal artery divides into an anterior and posterior branch, and the diameters of these vessels are similar. The anatomy of these two vessels is described, and implications for their use in reconstructive flaps are suggested.
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An aneurysm of the superficial temporal artery is a rare lesion, which should be suspected after blunt trauma to the forehead that is followed by the appearance of a pulsatile cystic lesion in the region of the superficial temporal artery. Treatment by excision of the aneurysm with ligation of the afferent and efferent arteries is curative. As this lesion may be mistaken clinically for an epidermal inclusion cyst, aneurysm should be included in the differential diagnosis prior to therapy.
Arteriovenous fistula of the superficial temporal artery is a rare condition most commonly caused by trauma. Traditional surgical treatment has been superseded by endovascular embolization. We present the case of a 40 year-old man with a traumatic arteriovenous fistula of the superficial temporal artery who was treated by endovascular embolization. The advantages of this approach are discussed, along with a brief history of the condition.
OBJECTIVE: This study investigated the hypothesis that high-resolution MRI can reveal mural inflammatory changes of the superficial temporal artery in giant cell arteritis (GCA). SUBJECTS AND METHODS: MRI of the temporal artery of 20 patients with suspected GCA was performed on a 1.5-T scanner using a dedicated eight-element phased-array head coil. Contrast-enhanced multislice T1-weighted spin-echo sequences were acquired perpendicular to the orientation of the vessel, with a submillimeter spatial resolution of 0.2 x 0.3 mm and a slice thickness of 3 mm. Mural thickness and lumen diameter of the temporal artery were measured, and mural contrast enhancement was graded on a four-point scale by two radiologists. For all patients, the MRI results were compared with the findings of clinical examination and laboratory tests. In addition, biopsy samples of the temporal artery were taken from 16 of these patients. RESULTS: MRI sharply demonstrated the superficial temporal artery, allowing an evaluation of its lumen and wall. Seventeen patients were GCA-positive according to criteria of the American College of Rheumatology. Of these 17, 16 had true-positive MRI findings and one had false-negative MRI findings. The 3 patients who were GCA-negative according to the American College of Rheumatology criteria had true-negative MRI findings. The mean thickness of the vessel wall and the lumen diameter were 0.88 +/- 0.23 mm and 0.78 +/- 0.29 mm, respectively, in GCA-positive patients and 0.57 +/- 0.25 mm and 0.7 +/- 0.1 mm, respectively, in GCA-negative patients. CONCLUSION: High-resolution contrast-enhanced MRI of the temporal artery allowed visualization of the temporal artery and evaluation of possible inflammation of the vessel wall. Our initial results with this noninvasive technique agreed well with histologic results and with the clinical criteria of the American College of Rheumatology.
OBJECTIVE: Occasionally, a temporal artery biopsy reveals small-vessel vasculitis (SVV) surrounding a spared temporal artery, the significance of which is unclear. We analyzed the final diagnosis in a series of patients with this condition and tried to identify histopathologic features with potential usefulness in predicting the ultimate diagnosis. METHODS: We performed a clinical and histopathologic review of 28 patients in whom SVV surrounding a spared temporal artery was the first histologic finding that led to the diagnosis of vasculitis. For comparison purposes, we analyzed the pattern of small vessel involvement in 30 patients with biopsy-proven giant cell arteritis (GCA). RESULTS: GCA was considered the most likely diagnosis in 12 patients, based on the absence of clinical evidence of additional organ involvement and normal findings on muscle biopsy and electrophysiologic study. Three patients had systemic necrotizing vasculitis (SNV), based on the demonstration of typical lesions on subsequent muscle, nerve, or kidney biopsy. After extensive evaluation, 4 patients remained unclassifiable. Nine patients were incompletely studied. Fibrinoid necrosis was significantly more frequent in patients with SNV (P = 0.0022), whereas involvement of vasa vasorum was more frequent in patients classified as having GCA (P = 0.022). No differences in the pattern of small vessel involvement were found in patients with SVV surrounding a spared temporal artery who were classified as having GCA compared with patients with biopsy-proven GCA. Granulocytes were observed at similar frequency in all conditions. CONCLUSION: SVV may be the only abnormal feature in a temporal artery biopsy and the only histologic evidence of vasculitis. The diagnosis of GCA can be reasonably established in most of these patients when there is no apparent evidence of additional organ involvement. However, when fibrinoid necrosis is observed or the temporal artery vasa vasorum are not involved, SNV must be extensively excluded.
Traumatic aneurysm of superficial temporal artery is an uncommon lesion. Blunt traumas of war, firearm, motorized vehicle and sport injuries are common causes. In this case, traumatic aneurysm of superficial temporal artery that occurs after scalp trauma in 74 years old male patient, was reported. Patient who suffers from a mass in his forehead ten days after trauma was admitted to our clinic. Selective angiography of the right temporal artery was performed as traumatic aneurysm was suspected upon the findings of physical examination and cranial computerized tomography studies. The aneurysm was detected. The proximal and distal part of the aneurysm was ligated and it was totally removed under general anesthesia. The histopathological investigation confirmed the presence of the traumatic aneurysm. Especially in hairy skin injuries, traumatic lesions should be considered as an aneurysm. Diagnosis, treatment, and surgical strategy must be planned by the help of these informations.
The temporal artery island flap, based on the anterior branch of the superficial temporal artery, was used in full thickness eyelid reconstructions of 11 patients (in four for both lids, in two for the upper lid and in five for extensive lower lid defects). The skin island was taken from the upper lateral frontal skin in front of the hairline to leave minimal scaring and create a long vascular pedicle. Mucosal or chondromucosal graft was used for the inner lining. In seven patients the arterial pedicle surrounded by a 0.5 cm wide band of subcutaneous tissue containing the corresponding veins, was tunnelled under the skin in a one stage procedure. In four cases, the pedicle was temporarily left above the skin to shorten the operating time. The temporal artery island flap is a reliable way of reconstructing both lids, or the lower lid in cases where the local flaps have been used in earlier operations. Because of the risk of bulging and for functional reasons, we do not recommend the flap for upper eyelid reconstructions.
Three cases of false aneurysms of the superficial temporal artery are reported. Most of these injuries are caused by trauma, frequently sports injuries, more rarely congenital or arteriosclerotic. Diagnosis is made by observation of a mass, usually pulsatile, in the distribution of this artery. Patients who present with a history of injury and a mass over the course of the superficial temporal artery should be suspected of having false aneurysm of the superficial temporal artery. Surgery is indicated to reduce the risk of hemorrhage from subsequent head trauma, to relieve headaches, and for any cosmetic defects.
OBJECTIVE: To test the diagnostic value of color Doppler sonography (CDS) of the superficial temporal arteries in patients suffering from giant cell arteritis (GCA). METHODS: The superficial temporal arteries and their frontal and parietal rami were examined by CDS in 11 patients with GCA, 21 patients with polymyalgia rheumatica (PMR), and 32 controls. The peak systolic velocity (Vmax) was measured at the tragus (proximal superficial temporal artery) and at the temporal bone (distal superficial temporal artery) level. Hypoechoic thickening of the vessel wall was systematically searched for. RESULTS: Mean Vmax in the proximal and distal superficial temporal artery was considerably lower in the GCA group [mean (+/- SEM) 30.9 (+/- 5.6) mm/s proximally and 5.8 (+/- 3.7) mm/s distally] compared to the PMR group [mean (+/- SEM) 64.6 (+/- 3.8) mm/s proximally and 49.3 (+/- 4.2) mm/s distally] and the control group [mean (+/- SEM) 56.9 (+/- 2.2) mm/s proximally and 42.6 (+/- 2.2) distally]. Thickening of the vessel wall was found in only 2 patients: one with GCA and one with PMR. Followup of CDS in 6 GCA patients under treatment produced evidence of a significant increase in the mean Vmax at the distal site. CONCLUSION: Decreased blood flow velocity in the superficial temporal artery is very common in GCA patients and rare in PMR patients. Therefore, CDS examination may contribute to the diagnosis of GCA.
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1. Endothelium-dependency of vasodilator responses was compared in helical strips of monkey cerebral and superficial temporal arteries contracted with prostaglandin F2 alpha. Acetylcholine produced an endothelium-dependent relaxation in the temporal arteries, but did not consistently alter the tone of cerebral arteries. 2. Adenosine 5'-triphosphate (ATP) produced a transient contraction followed by a relaxation in the temporal and cerebral arteries; removal of the endothelium partially attenuated the relaxation of the cerebral arteries and markedly suppressed the relaxation in the temporal arteries. The dependency of adenosine 5'-diphosphate (ADP)-induced relaxations on the endothelium was also greater in temporal arteries than in cerebral arteries. 3. Histamine-induced relaxations in the temporal arteries were independent of the endothelium and were reversed to contractions by cimetidine. Cerebral arterial relaxations induced by histamine were partly dependent on the endothelium. Relaxations caused by substance P were reversed to contractions by removal of the endothelium in the temporal arteries, whereas the peptide did not consistently alter the tone of cerebral arteries. 4. The Ca2+ ionophore, A23187, relaxed the temporal and cerebral arteries to a similar extent; removal of the endothelium abolished these relaxations. Glyceryl trinitrate elicited similar relaxation of cerebral and temporal arteries, and these were independent of the endothelium. 5. These findings clearly indicate heterogeneity in the endothelium-dependency of several vasodilator responses in monkey intra- and extracranial arteries, although the ability of these arteries to respond to A23187 and glyceryl trinitrate does not appear to differ. The heterogeneous responses observed so far could therefore be due to different distributions of receptors or to variation in receptor-effector coupling in endothelial cells.
BACKGROUND: Duplex sonography of the temporal artery may be helpful in the diagnosis of cranial arteritis. PATIENTS AND METHODS: The superficial temporal arteries of 36 patients with cranial arteritis or suspected arteritis were examined using both duplex ultrasonography (US) and biopsy. The data of these patients were divided into two groups. Group A consisted of 24 patients (66.7%) with definite positive results using duplex (US) and Group B of 12 patients (33.3%) who showed a suspicious or negative ultrasonographic result. RESULT: In all patients of Group A, the histological findings corresponded with the ultrasonographic changes in the inflamed artery. - The characteristic ultrasonographic sign was a dark halo around the lumen of the temporal arteries. There was a high correlation between a bilateral halo found by US with an ocular involvement. Ten out of 14 patients with a bilateral halo (71.4%) showed a distinct involvement of the optic nerve or retina. - The characteristic histological signs were infiltration of the vessel wall by inflammatory cells, mainly lymphocytes. Group B: The biopsies of the superficial temporal arteries were positive in 8 patients (66.7 %), negative in 4 other patients (33.3%). CONCLUSION: Patients with a distinct halo, demonstrated by US, also showed corresponding pronounced inflammatory cell infiltration of the vessel wall. Patients with no ultrasonographic changes presented histological signs of initial inflammation such as isolated inflammatory cells around the vasa vasorum and/or in the adventitial layer.
1. We investigated the hypothesis that, as in some other large human arteries, 5-HT-induced contraction of the temporal artery is mediated through two co-existing receptor populations, 5-HT1-like- and 5-HT2A. Temporal arterial segments were obtained from patients undergoing brain surgery and rings prepared set up to contract with 5-HT and related agents. Fractions of maximal 5-HT responses mediated through 5-HT1-like and 5-HT2A receptors, f1 and f2 = 1-f1, were estimated by use of the 5-HT2A-selective antagonist ketanserin. 2. In rings with intact endothelium 5-HT evoked contractions with a -log EC50, M of 7.0. Ketanserin (10-1000 nM) antagonized part of the 5-HT-induced contractions. Ketanserin-resistant components of 5-HT-induced contractions were found with -log EC50, M of 6.9 and f1 of 0.17 (100 nM ketanserin) and -log EC50, M of 6.4 and f1 of 0.20 (1000 nM ketanserin). 3. In rings with endothelial function attenuated by enzymatic treatment, 5-HT caused contractions with a -log EC50, M of 7.2 that were partially blocked by ketanserin. Ketanserin-resistant components of 5-HT-induced contractions were found with -log EC50, M 7.4 and f1 of 0.16 (100 nM ketanserin) and -log EC50, M of 7.5 and f1 of 0.14 (1000 nM ketanserin). 4. The ketanserin-resistant component of 5-HT-evoked contraction was blocked by methiothepin (100-1000 nM) consistent with mediation through 5-HT1-like receptors. 5. In rings with intact endothelium the 5-HT1-like-selective agonist, sumatriptan, caused small contractions with a -log EC50, M of 6.5 and intrinsic activity of 0.21 with respect to 5-HT that were resistant to blockade by 1000 nM ketanserin but antagonized by 100 nM methiothepin. 6. In rings with intact endothelium the 5-HT2A receptor partial agonist SK&F 103829 (2,3,4,5-tetrahydro-8[methyl sulphonyl]-1H3-benzazepin-7-ol methensulphonate) contracted rings with a -log EC50, M of 5.0 and an intrinsic activity of 0.49 with respect to 5-HT; the effects were antagonized by ketanserin 1000 nM. 7. We conclude that 80-86% of the maximum 5-HT-evoked contraction of human temporal artery is mediated through 5-HT2A receptors, the remainder through 5-HT1-like-receptors, regardless of whether or not endothelium is functional. The 5-HT1-like-receptors are more likely to be 5-HT1D beta receptors than 5-HT1D alpha receptors and sumatriptan is a full agonist for these receptors. As found in arteries of other species, SK&F 103829 is a partial agonist for 5-HT2A receptors of human temporal artery.
Traumatic aneurysm of the superficial temporal artery is an uncommon lesion. Two cases of post-traumatic superficial temporal artery aneurysm are presented.
PURPOSE: To determine the utility of unilateral versus bilateral temporal artery biopsies in detecting the pathologic changes of giant cell arteritis. METHODS: We performed a retrospective study to determine the utility of unilateral versus bilateral temporal artery biopsies in detecting the pathologic changes of giant cell arteritis. The pathologic reports of consecutive temporal artery biopsy specimens received at the Wilmer Ocular Pathology Laboratory over a 28-year period from 1968 to 1996 were reviewed. RESULTS: Of 908 specimens examined from 758 patients, 300 specimens were simultaneous bilateral biopsies from 150 patients, 72 specimens were bilateral sequential biopsies from 36 patients, and the remaining 536 specimens were unilateral biopsies from 536 patients. Of the 186 patients who had bilateral simultaneous or nonsimultaneous biopsies, 176 had identical diagnoses on both sides. In four patients, no artery was obtained on one side. In each of the remaining six patients, five of whom had bilateral simultaneous biopsies and one of whom had bilateral sequential biopsies performed 8 days apart, the biopsy specimen from one side was interpreted as showing only arteriosclerotic changes with no evidence of active or healed arteritis, whereas the other specimen was interpreted as showing either probable healed arteritis (three specimens) or possible early arteritis (three cases). In none of the six patients with differing diagnoses between the two sides was one side interpreted as showing definite, active giant cell arteritis. Five of the six patients were subsequently determined to have giant cell arteritis, based on a combination of clinical findings, erythrocyte sedimentation rate, and response to treatment with systemic corticosteroids. CONCLUSIONS: The results of this study indicate that performing a bilateral simultaneous or sequential temporal artery biopsy improves the diagnostic yield in at least 3% of cases of giant cell arteritis, whereas in 97% of cases, the two specimens show the same findings. Thus, in patients in whom only one artery can be biopsied, there is a high probability of obtaining the correct diagnosis. Nevertheless, although the improvement in diagnostic yield of bilateral temporal artery biopsies is low, the consequences of both delayed diagnosis and treatment of giant cell arteritis as well as the use of systemic corticosteroids in patients who do not have giant cell arteritis are of such potential severity that consideration should always be given to performing bilateral temporal artery biopsies in patients suspected of having the disease.
Eight dogs had a superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis, followed immediately by ligation of the ipsilateral middle cerebral artery. Subsequently, utilizing the radioactive microsphere technique, regional cerebral blood flow determinations were made both before and after ligation of the superficial temporal artery. A significant reduction in blood flow of 20-35% was noted in both cerebral hemispheres, caudate and thalamic nuclei, brain stem and cerebellum following occlusion of the bypass. It is our impression that this generalized reduction in flow is due to a redistribution of blood from normal areas previously supplied by the bypass. This implies that the newly created extracranial to intracranial arterial anastomosis reduces the shunting of blood from zones of higher to zones of lower flow through the circle of Willis and leptomeningeal collaterals. It also suggests a mechanism for the development in neurological function referable to areas of the brain remote from the bypass which is detected in some patients after STA-MCA anastomosis.
Six cases of severe epistaxis were treated with the super-selective intraarterial embolization of the internal maxillary artery. Tens of fragments of Gelfoam were delivered into the distal internal maxillary artery and, additionally, embolized by several pieces of the coils. In a case with cerebral infraction, catheter was inserted via the superficial temporal artery. There were no complications due to these procedures in all cases of this study. It is considered that therapeutic intraarterial embolization of the internal maxillary artery is an effective therapy for severe epistaxis and the superficial temporal artery approach is useful for selected cases.