J Neurol Surg B Skull Base 2012; 73(01): 048-053
DOI: 10.1055/s-0032-1304556
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Localization of the Internal Maxillary Artery for Extracranial-to-Intracranial Bypass through the Middle Cranial Fossa: A Cadaveric Study[*]

Jorge L. Eller
1   Department of Neurosurgery, Center for Cerebrovascular and Skull Base Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
,
Deanna Sasaki-Adams
1   Department of Neurosurgery, Center for Cerebrovascular and Skull Base Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
,
Justin M. Sweeney
1   Department of Neurosurgery, Center for Cerebrovascular and Skull Base Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
,
Saleem I. Abdulrauf
1   Department of Neurosurgery, Center for Cerebrovascular and Skull Base Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
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Publikationsverlauf

28. März 2011

16. August 2011

Publikationsdatum:
24. Februar 2012 (online)

Abstract

The internal maxillary artery (IMAX) is a promising arterial pedicle to function as a donor vessel for extracranial-to-intracranial (EC-IC) bypass procedures. The access to the IMAX through the anterior portion of the middle cranial fossa floor allows a much shorter interposition graft to be used to create a bypass to the ipsilateral middle cerebral artery and prevents a second incision in the neck. One of the challenges of this technique, however, is the difficulty to find the IMAX through an intracranial approach. The purpose of this cadaveric study is to establish a reliable method to localize the IMAX through a middle fossa floor approach based on skull base bone landmarks. In this study 5 latex-injected fixated cadaveric specimens were dissected bilaterally (providing a total of 10 IMAX dissections) to determine the precise location of the IMAX in the pterygopalatine fossa in relationship to bone landmarks of the middle fossa floor as seen through an intracranial approach. Drilling of the middle fossa floor was undertaken through both the originally described “anteromedial” approach, and a new “anterolateral” approach. Measurements were taken correlating the position of the IMAX to ipsilateral foramen rotundum, ipsilateral foramen ovale, posterior wall of the maxillary sinus, and distal V2 branches. Median and standard deviation were calculated for each dataset. The IMAX was found, within the pterygopalatine fossa, by drilling the greater wing of the sphenoid bone on average 10 mm anteriorly and 5 mm laterally to foramen rotundum, at an average depth of 8 mm. The IMAX was also found inferiorly to the maxillary nerve and laterally to the pterygoid head of the lateral pterygoid muscle. A more laterally oriented approach, consisting of drilling the greater wing of the sphenoid bone from a point perpendicular to foramen rotundum posteriorly to the sphenotemporal suture anteriorly, allowed for a longer segment of the IMAX to be easily identified and exposed facilitating its use as a donor vessel in bypass procedures. This cadaveric study provides a reliable and reproducible set of measurements to localize the IMAX within the pterygopalatine fossa through an intracranial middle fossa approach. The ability to find the IMAX consistently is an important step in exploring the possibility of using the IMAX as a routine donor vessel for EC-IC bypass procedures.

* This article was originally Published online in Skull Base on December 1, 2011 (DOI:10.1055/s-0031-1296036)


 
  • References

  • 1 Abdulrauf SI, Sweeney JM, Mohan YS, Palejwala SK. Short segment internal maxillary artery to middle cerebral artery bypass: a novel technique for extracranial-to-intracranial bypass. Neurosurgery 2011; 68 (3) 804-808, discussion 808–809
  • 2 Yasargil MG, Krayenbuhl HA, Jacobson II JH. Microneurosurgical arterial reconstruction. Surgery 1970; 67 (1) 221-233
  • 3 Lougheed WM, Marshall BM, Hunter M, Michel ER, Sandwith-Smyth H. Common carotid to intracranial internal carotid bypass venous graft. Technical note. J Neurosurg 1971; 34 (1) 114-118
  • 4 Sekhar LN, Duff JM, Kalavakonda C, Olding M. Cerebral revascularization using radial artery grafts for the treatment of complex intracranial aneurysms: techniques and outcomes for 17 patients. Neurosurgery 2001; 49 (3) 646-658, discussion 658–659
  • 5 Spetzler RF, Chater N. Occipital artery—middle cerebral artery anastomosis for cerebral artery occlusive disease. Surg Neurol 1974; 2 (4) 235-238
  • 6 Miller II CF, Spetzler RF, Kopaniky DJ. Middle meningeal to middle cerebral arterial bypass for cerebral revascularization. Case report. J Neurosurg 1979; 50 (6) 802-804
  • 7 Sekhar LN, Burgess J, Akin O. Anatomical study of the cavernous sinus emphasizing operative approaches and related vascular and neural reconstruction. Neurosurgery 1987; 21 (6) 806-816
  • 8 Sekhar LN, Sen CN, Jho HD. Saphenous vein graft bypass of the cavernous internal carotid artery. J Neurosurg 1990; 72 (1) 35-41
  • 9 Vrionis FD, Cano WG, Heilman CB. Microsurgical anatomy of the infratemporal fossa as viewed laterally and superiorly. Neurosurgery 1996; 39 (4) 777-785, discussion 785–786
  • 10 Ustün ME, Büyükmumcu M, Ulku CH, Cicekcibasi AE, Arbag H. Radial artery graft for bypass of the maxillary to proximal middle cerebral artery: an anatomic and technical study. Neurosurgery 2004; 54 (3) 667-670, discussion 670–671
  • 11 Allen III WE, Kier EL, Rothman SLG. The maxillary artery in craniofacial pathology. Am J Roentgenol Radium Ther Nucl Med 1974; 121 (1) 124-138
  • 12 Berkovitz BKB. Infratemporal region and pterygopalatine fossa. In: Gray’s Anatomy. 39th ed. New York: Churchill Livingstone; 2005: 519-526
  • 13 Osborn AG. The external carotid vasculature. In: Diagnostic Cerebral Angiography. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 1999: 31-55