Comments on the history of external-internal anastomosis for cerebral ischemia

We owe the concept of cerebral revascularization as a treatment for stroke to Henschen,(2) who, in 1950, performed a revascularization of the brain on a 44-year-old patient with bilateral carotid stenosis and epilepsy. This operation consisted in the transplantation of a pedicle of temporalis muscle over the surface of the brain via bilateral temporoparietal craniotomy. The operation was designated encephalomyosynangiosis, and the patient was reported to have improved. The epileptic seizures came to an end, but angiographic confirmation of graft function was not achieved. A second important attempt at reconstruction of intracranial circulation was made in 1963 by Woringer and Kunlin,(10) who demonstrated that anastomosis between the common carotid artery and the intracranial carotid or the middle cerebral artery with a venous autograft from the internal saphenous vein is feasible, thus reestablishing the circulation in a case of internal carotid artery thrombosis. Unfortunately the patient died from cardiac arrest due to pulmonary embolism.