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ARTICLE |

Neurosurgery FREE

Nicholas T. Zervas, MD
JAMA. 1981;245(21):2230-2231. doi:10.1001/jama.1981.03310460082040
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Cranial Artery Bypass  Neurosurgeons today are involved in many areas of general concern. One of these, occlusive cerebrovascular disease, is a prevalent and potentially devastating problem, and a great effort is under way to prevent or treat this disorder. Extracranial-intracranial arterial bypass to circumvent obstruction of the carotid and vertebral arteries in the neck or base of the skull has received wide attention. It involves the anastomosis of vessels of 1 to 2 mm in diameter from the scalp to vessels of similar diameter on the surface of the brain. When performed by experienced neurosurgeons using microsurgical technique, the operative mortality and morbidity are low (less than 5%).1 Typically, these small vessels can adequately perfuse brain areas made ischemic by proximal occlusive lesions. For example, proximal surgical occlusion of the middle cerebral artery to trap a distal giant aneurysm is often tolerated if a distal middle-cerebral arterial branch is

REFERENCES

Sampson DS, Boone S:  Extracranial-intracranial (EC-IC) bypass: Past performance and current concepts . Neurosurgery 1978;;3:79-86.
Barnett HJ, Peerless SJ, McCormick CW:  In answer to the question: 'As compared to what?' A progress report on the EC/IC bypass study . Stroke 1980;;11:137-140.
Marshall LF, Smith RW, Shapiro HM:  The outcome with aggressive treatment in severe head injuries: II. Acute and chronic barbiturate administration in the management of head injury . J Neurosurg 1979;; 50:26-30.
Scanlon PW, Taylor WF:  Radiotherapy of intracranial astrocytomas: Analysis of 417 cases treated from 1960 to 1969 . Neurosurgery 1979;; 5:301-308.
Walker MD, Alexander E Jr, Hunt WE, et al:  Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: A cooperative clinical trial . J Neurosurg 1978;;49:333-343.
Hochberg FH, Parker LM, Takvorian T, et al:  High-dose BCNU with autologous bone marrow rescue for recurrent glioblastoma multiforme . J Neurosurg , to be published.
Neuwelt EA, Frenkel EP, Diehl J:  Reversible osmotic blood-brain barrier disruption in humans: Implications for the chemotherapy of malignant brain tumors . Neurosurgery 1980;;7:44-52.
Sweet WH, Smith BH:  Neuroscience for the neurosurgeon: The neuropeptides and behavior . Neurosurgery 1978;;2:62-69.
Akil H, Richardson DE, Barchas JD, et al:  Appearance of beta-endorphin-like immunoreactivity in human ventricular cerebrospinal fluid upon analgesic electrical stimulation . Proc Natl Acad Sci USA 1978;; 75:5170-5172.
Hosobuchi Y, Rossier J, Bloom FE:  Oral loading with L-tryptophan may augment the simultaneous release of ACTH and beta-endorphin that accompanies periaqueductal stimulation in humans . Adv Biochem Psychopharmacol 1980;;22:563-570.
Poletti C, Sweet WH, Zervas NT:  Cancer pain relieved by long-term epidural morphine: Two case reports for permanent indwelling systems for self-administration . J Neurosurg , to be published.
Sweet WH:  Central mechanisms of chronic pain (neuralgias and certain other neurogenic pain) . Res Publ Assoc Res Nerv Ment Dis 1980;;58:287-303.
Haines SJ, Martinez AJ, Jannetta PJ:  Arterial cross compression of the trigeminal nerve at the pons in trigeminal neuralgia: Case report with autopsy findings . J Neurosurg 1979;;50:257-259.

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Sampson DS, Boone S:  Extracranial-intracranial (EC-IC) bypass: Past performance and current concepts . Neurosurgery 1978;;3:79-86.
Barnett HJ, Peerless SJ, McCormick CW:  In answer to the question: 'As compared to what?' A progress report on the EC/IC bypass study . Stroke 1980;;11:137-140.
Marshall LF, Smith RW, Shapiro HM:  The outcome with aggressive treatment in severe head injuries: II. Acute and chronic barbiturate administration in the management of head injury . J Neurosurg 1979;; 50:26-30.
Scanlon PW, Taylor WF:  Radiotherapy of intracranial astrocytomas: Analysis of 417 cases treated from 1960 to 1969 . Neurosurgery 1979;; 5:301-308.
Walker MD, Alexander E Jr, Hunt WE, et al:  Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: A cooperative clinical trial . J Neurosurg 1978;;49:333-343.
Hochberg FH, Parker LM, Takvorian T, et al:  High-dose BCNU with autologous bone marrow rescue for recurrent glioblastoma multiforme . J Neurosurg , to be published.
Neuwelt EA, Frenkel EP, Diehl J:  Reversible osmotic blood-brain barrier disruption in humans: Implications for the chemotherapy of malignant brain tumors . Neurosurgery 1980;;7:44-52.
Sweet WH, Smith BH:  Neuroscience for the neurosurgeon: The neuropeptides and behavior . Neurosurgery 1978;;2:62-69.
Akil H, Richardson DE, Barchas JD, et al:  Appearance of beta-endorphin-like immunoreactivity in human ventricular cerebrospinal fluid upon analgesic electrical stimulation . Proc Natl Acad Sci USA 1978;; 75:5170-5172.
Hosobuchi Y, Rossier J, Bloom FE:  Oral loading with L-tryptophan may augment the simultaneous release of ACTH and beta-endorphin that accompanies periaqueductal stimulation in humans . Adv Biochem Psychopharmacol 1980;;22:563-570.
Poletti C, Sweet WH, Zervas NT:  Cancer pain relieved by long-term epidural morphine: Two case reports for permanent indwelling systems for self-administration . J Neurosurg , to be published.
Sweet WH:  Central mechanisms of chronic pain (neuralgias and certain other neurogenic pain) . Res Publ Assoc Res Nerv Ment Dis 1980;;58:287-303.
Haines SJ, Martinez AJ, Jannetta PJ:  Arterial cross compression of the trigeminal nerve at the pons in trigeminal neuralgia: Case report with autopsy findings . J Neurosurg 1979;;50:257-259.
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