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Paul Steinbok, Kenneth Berry and Clarisse L. Dolman

to unaccustomed arterial pressure and flow, an explanation that would not satisfy the conditions in the situation described in this paper. Internal mammary artery to coronary artery bypass grafts have been reported to show, radiologically, areas of vessel narrowing. 1, 10 Furthermore, radial artery grafts for aortocoronary bypass have been shown to occlude by development of intimal hyperplasia, which is thought likely to be due to failure of regeneration of the vasa vasorum. 6 This raises the question of possible damage to the vasa vasorum of the terminal portion

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Benjamin R. Gelber and Thoralf M. Sundt Jr.

undergone a right carotid ligation in combination with an intracranial trapping of a right intracavernous carotid aneurysm. She remained well until June, 1977, when she developed severe left retro-orbital headache and ptosis. Examination revealed a left third-nerve palsy and a left Horner's syndrome. Angiography, performed before her arrival here, had shown an occlusion of the right ICA and a large left intracavernous aneurysm. She did not have an adequate temporal artery for an STA-MCA anastomosis and, therefore, a free radial artery graft was used to establish an

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Robert F. Spetzler, Robert S. Rhodes, Richard A. Roski and Matt J. Likavec

artery to the MCA has been described, as well as one case of a radial artery graft from the vertebral to posterior inferior cerebellar artery. 2, 21 We are reporting a variation of an EIAB procedure that has certain advantages over previously reported techniques. Using an autologous saphenous vein graft, we perform a subclavian to MCA anastomosis in patients in whom an extracranial donor artery is inadequate, unavailable, or when an immediate high-flow bypass is required. Operative Technique The greater saphenous vein is harvested by exposing, rather than

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Robert F. Spetzler, Richard A. Roski, Robert S. Rhodes and Michael T. Modic

retinal ischemia. Surg Neurol 9: 5–8, 1978 2. Ausman JI , Nicoloff DM , Chou SN : Posterior fossa revascularization: anastomosis of vertebral artery to PICA with interposed radial artery graft. Surg Neurol 9 : 281 – 286 , 1978 Ausman JI, Nicoloff DM, Chou SN: Posterior fossa revascularization: anastomosis of vertebral artery to PICA with interposed radial artery graft. Surg Neurol 9: 281–286, 1978 3. Barnes WT , Jacoby GE : Aneurysm of the common carotid artery due to cystic medial necrosis

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Ryoji Ishii, Tetsuo Koike, Shigekazu Takeuchi, Shigeaki Ohsugi, Ryuichi Tanaka and Kimikazu Konno

. Acknowledgments The authors wish to thank Mr. K. Uesugi for the photographs and Miss S. Hoshino for the preparation of this manuscript. References 1 Ausman JI , Nicoloff DM , Chou SN : Posterior fossa revascularization: anastomosis of vertebral artery to PICA with interposed radial artery graft. Surg Neurol 9 : 281 – 286 , 1978 Ausman JI, Nicoloff DM, Chou SN: Posterior fossa revascularization: anastomosis of vertebral artery to PICA with interposed radial artery graft. Surg Neurol 9: 281–286, 1978 2 Chater N

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Vertebrobasilar insufficiency

Part 2: Microsurgical treatment of intracranial vertebrobasilar disease

Leo N. Hopkins, Neil A. Martin, Mark N. Hadley, Robert F. Spetzler, James Budny and L. Philip Carter

interposed radial artery graft. Surg Neurol 9 : 281 – 286 , 1978 Ausman JI, Nicoloff DM, Chou SN: Posterior fossa revascularization: anastomosis of vertebral artery to PICA with interposed radial artery graft. Surg Neurol 9: 281–286, 1978 7. Bogousslavsky J , Gates PC , Fox AJ , et al : The clinical spectrum of atherosclerotic bilateral occlusion of the vertebral artery. Neurology 35 ( Suppl 1 ): 214 , 1985 (Abstract) Bogousslavsky J, Gates PC, Fox AJ, et al: The clinical spectrum of atherosclerotic

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Laligam N. Sekhar, Chandra N. Sen and Hae Dong Jho

carotid bypass venous graft. Technical note. J Neurosurg 34: 114–118, 1971 11. Morimoto T , Sakaki T , Kakizaki T , et al : Radial artery graft for an extracranial-intracranial bypass in cases of internal carotid aneurysms. Report of two cases. Surg Neurol 30 : 293 – 297 , 1988 Morimoto T, Sakaki T, Kakizaki T, et al: Radial artery graft for an extracranial-intracranial bypass in cases of internal carotid aneurysms. Report of two cases. Surg Neurol 30: 293–297, 1988 12. Pearce JE , Dujovny M

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Fjodor A. Serbinenko, Jury M. Filatov, Aldo Spallone, Mikhail V. Tchurilov and Valery A. Lazarev

unruptured giant carotid aneurysm after superficial temporal-middle cerebral artery bypass and internal carotid occlusion. Neurosurgery 16 : 177 – 184 , 1985 Masuda M, Shiino A, Handa J: Rupture of previously unruptured giant carotid aneurysm after superficial temporal-middle cerebral artery bypass and internal carotid occlusion. Neurosurgery 16: 177–184, 1985 12. Morimoto T , Sakaki T , Kakizaki T , et al : Radial artery graft for an extracranial-intracranial bypass in cases of internal carotid aneurysms. Report of two

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Norihiko Tamaki, Shigekuni Kim, Kazumasa Ehara, Masahiro Asada, Katsuzo Fujita, Katsushi Taomoto and Satoshi Matsumoto

ligation and its role in the management of intracranial aneurysms. J Neurol Neurosurg Psychiatry 40: 64–72, 1977 17. Morimoto T , Sakaki T , Kakizaki T , et al : Radial artery graft for an extracranial-intracranial bypass in cases of internal carotid aneurysms. Report of two cases. Surg Neurol 30 : 293 – 297 , 1988 Morimoto T, Sakaki T, Kakizaki T, et al: Radial artery graft for an extracranial-intracranial bypass in cases of internal carotid aneurysms. Report of two cases. Surg Neurol 30: 293–297, 1988 18

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Kenji Wakui, Shigeaki Kobayashi, Toshiki Takemae, Yukihiro Kamijoh, Hisashi Nagashima and Shinsuke Muraoka

intracranial aneurysms. J Neurol Neurosurg Psychiatry 45: 1040–1047, 1982 13. Yamaura A : Diagnosis and treatment of vertebral aneurysms. J Neurosurg 69 : 345 – 349 , 1988 Yamaura A: Diagnosis and treatment of vertebral aneurysms. J Neurosurg 69: 345–349, 1988 14. Yasui N , Ohta H , Suzuki A , et al : Cervical carotid artery to middle cerebral artery anastomosis with interposed radial artery graft , in Spetzler RF , Carter LP , Selman WR , et al (eds): Cerebral