Summary
Cerebral vascular insufficiency due to occlusive lesions regarded as inaccessible is a common problem. The degree of cerebral dysfunction associated with such lesions is dependent in part on the amount of collateral circulation present. By anastomosing the superficial temporal artery to a branch of the middle cerebral artery an increase in collateral circulation is provided to the affected hemisphere. This report describes the results of twenty such procedures. Postoperative angiography demonstrates a 90% patency rate. There is frequent neurological improvement following surgery, and the rate of new TIA's or strokes seems less than would be expected. The most damaging complication of the procedure ist intracerebral haemorrhage. The indications for, and the complications of, such procedures are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Guidelines for stroke care. Edited by Sahs, A. L. Hartman, E. C., and Aronson, S. M., US Government Printing Office, Washington, 1976.
Barnett, H. J. M., Pathogenesis of transient ischemic attacks. In: Cerebrovascular Disease: Tenth Princeton Conference. Edited by Scheinberg, P., p. 1. New York: Raven Press. 1976.
Gurdjian, E. S., Lindner, D. W., Hardy, W. G., Thomas, L. M., Completed stroke due to occlusive vascular disease. Neurol.11 (1961), 724.
Toole, J. F., Janeway, R., Choi, K., Cordell, R., Davis, C., Johnston, F., Miller, H., TIA's due to atherosclerosis. A preoperative study of 160 patients. Arch. Neurol.32 (1975), 5.
Hutchinson, E. C., Acheson, E. J., Strokes, natural history, pathology and surgical treatment. Major problems in neurology, Vol. 4. Edited by Walton, J. N. London: W. B. Saunders Co. Ltd. 1975.
Genton, E., Barnett, H. J. M., Fields, W. S., Crent, M., Hoak, J. C., Report from the joint committee for stroke resources XIV. Cerebral Ischemia: The role of thrombosis and of antithrombotic therapy. Stroke8 (1977), 150.
Grindal, A. B., Toole, J. F., Surgical treatment of carotid and vertebral artery disease. An updating to 1974. Ann. Int. Med.81 (1974), 647.
Ojemann, R. G., Crowell, R. M., Roberson, G. H., Fischer, C. M., Surgical treatment of extracranial carotid occlusive disease. Clin. Neurosurg.22 (1974), 214.
Fields, W. S., Maslenikov, V., Meyer, J. S., Hass, W. K., Remington, R. D., Macdonald, M., Joint study of extracranial arterial occlusion. A progress report of prognosis following surgery or non surgical treatment for transient cerebral ischemic attacks and cervical carotid artery lesions. JAMA211 (1970), 1993.
Thompson J. R., Simmons, C. R., Tsao, E., Angiography of brain ischemic and the superficial temporal artery-middle cerebral artery anastomosis candidate. In: Microneurosurgical anastomoses for cerebral ischemia, Edited by Austin, G. M., p. 157. Springfield, Ill.: Ch. C Thomas. 1976.
Fields, W. S., Lemak, N. A., Joint study of extracranial arterial occlusion X. Internal Carotid Artery Occlusion. JAMA235 (1976), 2734.
Kaste, M., Waltino, O., Prognosis of patients with middle cerebral artery occlusion. Stroke7 (1976), 482.
Fisher, C. M., The natural history of carotid occlusion. In: Microneurosurgical anastomosis for cerebral ischemia. Edited by Austin, G. M., p. 194. Springfield, Ill.: Ch. C Thomas. 1976.
Donaghy, R. M. P., Yaşargil, M. G., Extra-intracranial blood flow diversion. American Association of Neurological Surgeons. Chicago, Ill.: April 11, 1968 (Abstract No. 52).
Holbach, K. H., Wassman, H., Bodosi, M., Bonatelli, A. P., Superficial temporal-middle cerebral artery anastomosis for internal carotid occlusion. Acta Neurochir. (Wien)37 (1977), 219–244.
Bannister, C. M., Weiler, J. M., Surgical revascularisation of the cerebral cortex. Brit. med. J.2 (1977), 740–741.
Chater, N., Popp, J., Microsurgical vascular bypass for occlusive cerebrovascular disease: Review of 100 cases. Surg. Neurol.6 (1976), 115.
Sundt, J. M., Siekert, R. G., Piepgras, D. G., Sharbrough, F. W., Houser, D. W., Bypass surgery for vascular disease of the carotid system. Mayo Clin. Proc.51 (1976), 677.
Gratzl, O., Schmiedek, P., Spetzler, R., Steinhoff, H., Marguth, F., Clinical experience with extra-intracranial arterial anastomosis in 65 cases. J. Neurosurg.44 (1976), 313.
Reichmann, O. H., Neurosurgical microsurgical anastomosis for cerebral ischemia: Five years experience. In: Cerebrovascular disease, Tenth Princeton Conference. Edited by Scheinberg, P., p. 311. New York: Raven Press. 1976.
Austin, G., Laffin, D., Hayward, W., Microcerebral anastomosis for the prevention of stroke. In: Microneurosurgery. Edited by Handa, H., p. 47. Baltimore: University Park Press. 1975.
Schmidek, P., Gratzl, O., Olteanu, V., Steinhoff, H., Baethmann, A., Enzenback, A., The contribution of regional cerebral blood flow measurement to the microneurosurgical treatment of cerebral ischemia. In: Microneurosurgical anastomoses for cerebral ischemia. Edited by Austin, G. M., p. 244. Springfield, Ill.: Ch. C Thomas. 1976.
Reichman, O. H., Complications of cerebral revascularization. Clinical Neurosurg.23 (1976), 318.
Gratzl, O., Schmiedek, P., Steinhoff, H., Extra-intracranial arterial bypass in patients with occlusion of cerebral arteries due to trauma or tumor. In: Microneurosurgery. Edited by Handa, H., p. 68. Baltimore: University Park Press. 1975.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hodge, C.J., Gross, C.E. Cerebral revascularization. Acta neurochir 44, 115–130 (1978). https://doi.org/10.1007/BF01401635
Issue Date:
DOI: https://doi.org/10.1007/BF01401635