External carotid-middle cerebral artery bypass using free graft bypass
Neurology and neurosurgery have lagged behind the rest of the medical profession in vascular reconstruction procedures. Until recently, the surgical treatment of impending stroke was largely restricted to large vessel surgery in the chest and neck. However, as far back as 1955, Welch described a successful embolectomy in the middle cerebral artery which was done without the aid of the surgical microscope(5) and Henschen, in 1944, transplanted a pedicle of temporalis musce over the surface of brain in an attempt to revascularize the brain. (2) A major change in direction occurred in 1967 when Donaghy(1) and Yasargil(6) demonstrated that by using the operating microscope one could successfully anastomose a superficial temporal artery to a cortical branch of the middle cerebral artery. This procedure now appears to be the basis for reconstructing an inadequate cerebral circulation when large vessel surgery in the neck is not possible. However, on a number of occasions we have been disappointed in that a number of individuals do not have superficial temporal arteries of adequate size to anastomose to the available cortical vessels.
KeywordsMiddle Cerebral Artery Saphenous Vein Superficial Temporal Artery Sylvian Fissure Occipital Artery
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