Surgical Production of Collateral Intracranial Circulation. An Experimental Study

Abstract

Beck 1 , 2 3 and O'Shaughnessy 4 , 5 , 6 have demonstrated that an effective collateral blood supply to the heart can be established by the use of pedicled muscle and omental grafts. Others 7 , 8 9 have similarly employed the omentum to augment the circulation to the kidneys. The present experiments 10 were performed to determine whether an accessory arterial blood supply from an extracranial source could be provided for the brain by applying to its cortical surface a pedicled graft of temporal or suboccipital muscles.

Monkeys (Macaca mulatta) weighing 2 to 3 kilos were used as experimental animals. The operative approach and technic, as well as the sequence of the procedures, varied slightly during the course of the experiments, but the main objectives in each instance remained the same. After either preliminary or concomitant ligation of one or more of the main arteries to the brain, the superior border of the temporal muscle was separated from its origin and reflected to expose most of the underlying squamous portion of the temporal bone. The muscle was left attached at its insertion and its blood and nerve supply not disturbed. A large defect was made in the temporal bone, the exposed dura excised, and the underlying arachnoid peeled gently away from the cerebral convolutions. The periosteal surface of the temporal muscle was scarified and applied directly to the denuded brain. The superior border of the muscle was sutured to the remaining free edge of the dura at the margin of the bony defect. No sutures were placed between the muscle and the brain itself. In 2 of the animals pedicled grafts of the suboccipital muscles were placed over the cerebellar hemispheres in addition to the bilateral temporal grafts.