Temporal Artery Biopsy

During your consultation, your doctor will review your symptoms, examine your scalp and temples, and assess the results of any blood tests. If giant cell arteritis is suspected, corticosteroid treatment is started immediately to protect eyesight. Biopsy is ideally performed within 1 week and within 2 weeks if feasible; histologic changes often persist for several weeks after steroids, but sensitivity decreases over time. Your medication history will also be reviewed, especially blood-thinning drugs. You may be advised to stop some before the procedure. Never stop these medicines without personalised advice.

Before surgery, the surgeon may use a Doppler ultrasound to identify the best artery segment for sampling while avoiding nearby facial nerve branches. The incision is often planned just behind the hairline to reduce visible scarring. Hair in the area may be trimmed, and the skin is cleaned with an antiseptic solution to minimise infection risk.

A temporal artery biopsy is usually performed as an outpatient day procedure so that you can go home the same day. Local anaesthetic is used, meaning you will be awake, but the area is thoroughly numbed, so you will not feel any pain.

Once the skin is numbed, the surgeon makes a small incision, usually 1-2 centimetres long, over the artery at your temple. A segment of artery, ideally at least 2-3 centimetres, is removed to reduce the chance of a false negative (where the condition is missed). Any small branches of the artery are tied off to prevent bleeding, and the wound is closed with delicate stitches or skin glue.

The procedure usually takes between 30 and 60 minutes in total. In some cases, if the first biopsy is negative but suspicion remains high, your doctor may recommend repeating a biopsy on the other side (contralateral) to improve accuracy.

Some bruising, mild swelling, or tenderness around the incision site is expected and usually settles within a week. Stitches are typically removed after 7 to 10 days, either by your GP or by the surgeon. During the first 24 to 48 hours, the wound should be kept dry and covered, and hair washing should be avoided until your doctor advises it is safe to do so.

You should contact your healthcare team straight away if you notice increasing redness, warmth, swelling around the wound, unusual discharge, fever, or severe pain that does not improve with simple painkillers. Prompt review is also advised if you notice red streaks extending from the wound, as this may indicate an infection.

Understanding your results

Pathology results are typically available within 1 to 3 weeks. A positive biopsy confirms the diagnosis by showing inflammation in the artery wall, sometimes with giant cells.

A negative biopsy does not entirely rule out giant cell arteritis, because the disease may be present in another part of the artery that was not sampled. In these cases, your doctor may continue treatment with corticosteroids if your symptoms, blood tests, or scans strongly suggest the condition.

The biopsy results are essential because they guide decisions about how long you will need steroid treatment and how quickly doses can be tapered. Positive results typically indicate a longer course of treatment, while negative results may necessitate further investigations or consideration of alternative diagnoses.

Risks and complications

Temporal artery biopsy is a safe procedure, but like all surgery, it carries some risks. The most common are mild bruising, swelling and temporary numbness or tingling in the skin near the scar. Some people experience mild discomfort, which is typically well-managed with over-the-counter pain relief. Rarely, damage to the frontal (temporal) branch of the facial nerve can occur, causing weakness in raising the eyebrow on the affected side. This is usually a temporary condition that resolves with time. Infection and bleeding are possible but uncommon, and more serious complications such as stroke, scalp necrosis, or permanent nerve damage are extremely rare when an experienced surgeon performs the procedure.

False negatives are not uncommon: TAB has very high specificity (~98%) but only moderate sensitivity (~60–77%). Inflammation can be patchy (‘skip lesions’), so a normal-looking segment does not rule out disease.