Name of the Procedure:

Ligation or Biopsy of the Temporal Artery (Temporal Artery Biopsy)

Summary

A temporal artery biopsy is a minor surgical procedure in which a small section of the temporal artery, located near the temples on either side of the head, is removed for examination. This helps diagnose certain conditions, particularly giant cell arteritis.

Purpose

The procedure is primarily used to diagnose giant cell arteritis (GCA), an inflammation of the arteries that can cause headaches, vision problems, and other serious health issues. The biopsy aims to confirm the presence of GCA so that appropriate treatment can be started promptly.

Indications

• Persistent headaches, particularly around the temples
• Scalp tenderness
• Jaw pain or difficulty chewing
• Vision problems, including sudden loss of vision
• Symptoms suggesting giant cell arteritis
• Elevated inflammatory markers like ESR or CRP in blood tests

Preparation

• Fasting may not be necessary.
• Medication adjustments, particularly blood thinners, may be required.
• Blood tests, such as an erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), may be performed before the procedure.

Procedure Description

1. The patient lies on an exam table.
2. The surgical site is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. The surgeon makes a small incision in the skin near the temple.
5. A small section of the temporal artery is carefully removed.
6. The incision is closed with sutures.
7. The tissue sample is sent to a pathology lab for analysis.

Duration

The procedure typically takes about 30-60 minutes.

Setting

The procedure can be performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Surgeon (often a vascular surgeon or a neurosurgeon)
• Nursing staff
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Infection at the biopsy site
• Bleeding or bruising
• Nerve damage causing temporary or permanent numbness
• Scarring
• Pain or discomfort at the incision site

Benefits

• Accurate diagnosis of giant cell arteritis
• Allows for timely initiation of appropriate treatment
• Can prevent serious complications like vision loss or stroke associated with untreated GCA

Recovery

• Patients may be given pain medication to manage discomfort.
• Keep the biopsy site clean and dry.
• Follow specific care instructions for the incision site.
• Sutures may be removed in about 7-10 days.
• Most patients can resume normal activities within a few days, but heavy exertion should be avoided until the site heals fully.

Alternatives

• Clinical diagnosis based on symptoms and blood tests without biopsy, though less accurate.
• Non-invasive imaging tests, though they can be less definitive.
• Empirical treatment with steroids without biopsy, which carries risks of side effects without confirming diagnosis.

Patient Experience

• The patient may feel a slight pinch during anesthesia injection.
• Once the anesthesia takes effect, the procedure itself should be painless.
• Mild discomfort or soreness at the incision site can be expected post-procedure.
• Pain management typically involves over-the-counter pain relievers, and any significant discomfort should be reported to the healthcare provider.

This procedure is crucial for diagnosing giant cell arteritis and ensuring timely treatment to prevent serious complications.