Anatomical studies of the posterior circulation relevant to occipital artery bypass
With the advent of microsurgical techniques, extra- to intracranial arterial anastomosis has become technically feasible for the treatment of inoperable or inaccessible intra- or subcranial occlusive cerebrovascular disease.(1) Patency rates for end-to-side superficial temporal to middle cerebral artery anastomosis are acceptable at 90%, morbidity rates are 2%, and collateral augmentation has been documented angiographically as well as with clinical and experimental cerebral blood flow studies. (2,4,6,7,11,12) The value of such procedures for preventing completed stroke in patients suffering transient ischemic attacks will be demonstrated only when a large randomized study has been performed. Previous work in our laboratory has shown that a cortical branch of the middle cerebral artery at least 1 mm in diameter could be found under a 4-cm craniectomy centered 6 cm above the external auditory meatus, in 90% of 50 brains dissected. (5) The purpose of the current study was to determine if the occipital artery could be used for anastomosis, with suitable cerebellar or cerebral cortical branches, in patients with vertebrobasilar occlusive disease.
KeywordsBasilar Artery Posterior Circulation Blood Flow Measurement External Auditory Meatus Occipital Artery
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- 1.Austin GM (ed): Microsurgical Anastomosis for Cerebral Ischemia. Springfield, Ill. Thomas, 1974Google Scholar
- 2.Austin G, Laffin D, Hayward W: Cerebral blood flow and pressure in patients undergoing STA-MCA anastomosis. Presented at the Second International Symposium on Microneurosurgical Anastomoses, Chicago, June 1974Google Scholar
- 3.Bradshaw P, McQuaid P: The syndrome of vertebro-basilar insufficiency. J Med 128:279, 1963Google Scholar
- 4.Chater N, Peerless SJ: The early effects of neurosurgical microvascular bypass operations on problems of cerebrovascular occlusive disease. Presented at the American Academy of Neurology Meeting, San Francisco, April 1974Google Scholar
- 5.Chater N, Spetzler R: Anatomical studies of the cerebral cortical vasculature of microvascular surgical significance. Presented at the Symposium on Microneurosurgery, Kyoto, Japan, October 14–15, 1973Google Scholar
- 9.Meyer JS, Sheehan S, Bauer RB: An arteriographic study of cerebrovascular disease in man. Arch Neurol 2:37, 1960Google Scholar
- 11.Schmiedek P, Steinhoff H, Gratzl O. Current status of regional blood flow measurement in revascularization microsurgery of the brain. Presented at the Second International Symposium on Microneurosurgical Anastomoses, Chicago, June 1974Google Scholar
- 12.Spetzler RF, Chater N: Superficial temporal artery-middle cerebral artery blood flow measurements. Presented at the American Association of Neurological Surgeons Meeting, St. Louis, April 1974Google Scholar