Extracranial to Intracranial Microvascular Anastomosis: A New Approach to the Treatment of Cerebrovascular Disease

Abstract

It is estimated that in the United States alone, 200,000 new strokes occur annually, of which, at least 10% are the result of multiple extracranial or surgically inaccessible intracranial lesions, considered “inoperable” by conventional techniques (1). Recent advances in microsurgery allow revascularization to be undertaken in such patients. The most widely used procedure, first performed by Yasargil in 1967, is an end-to-side anastomosis between the superficial temporal artery and a cortical branch of the middle cerebral artery, vessels only slightly greater than 1 mm in diameter (4). Experience to date indicates that operative mortality and morbidity is less than 5% and that long term anastomosis patency rates approaching 100% are possible (2, 3). The principal difficulty with the procedure has been accurate delineation of the indications for its use in view of the broad clinical spectrum of cerebrovascular disease and the wide variety of lesions which may result in threatened or actual stroke.