Anatomic pathways facilitating middle cerebral artery bypass.

Abstract

Occlusion of the middle cerebral artery by thrombi is a relatively common occurrence resulting in stroke. Prompt intervention by dissolution or bypassing the thrombi could reduce the severity of the effects. Here, the anatomic pathways facilitating a bypass are explored. Four possible arteries, the two superficial temporals, left and right, and two middle meningeals, left and right, are in positions adjacent to branches of the middle cerebral arteries, the trunks of which are located in the lateral fissures of the brain. The first possibility is anastomosing a branch of the superficial temporal artery with the middle cerebral artery segment in the lateral fissure where this segment is usually clear of thrombi. The second possibility is anastomosing a branch of the middle meningeal artery with the postthrombotic segment of the middle cerebral artery. These anastomoses are to be done with donor and recipient arteries of the same side. In the unlikely event that these two possibilities are lost, it is still possible to anastomose the affected middle cerebral artery with the superficial temporal or middle meningeal artery of the opposite side using several inches of saphenous vein.