Hemodynamic and electrophysiological evaluation following extracranial/intracranial bypass surgery.

We examined 50 patients with an extracranial/intracranial bypass using transcranial Doppler blood flow mapping, somatosensory evoked potentials, and computer-assisted EEG analysis. The investigation was supplemented by temporary compression of the extracranial supplying vessel. Transcranial Doppler sonography revealed in addition to 4 patients with nonpatent anastomoses, a bypass-mediated retrograde flow in the ipsilateral middle cerebral artery beyond a depth of 40 mm in the majority of patients. In 9 patients, retrograde flow could be demonstrated in the whole proximal (M1) MCA segment. The precommunicating segment of the anterior cerebral artery (A1) could be reliably insonated in all but 5 patients. Bypass-compression dependent alterations in the SSEP and in EEG analysis were only observed in a small number of patients. Transcranial Doppler sonography, with the aid of the flow mapping system, appears therefore, to be a reliable and repeatedly performable noninvasive technique for the assessment of intracranial hemodynamics following bypass surgery.