J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244
DOI: 10.1055/s-0039-1679668
Poster Presentations
Georg Thieme Verlag KG Stuttgart · New York

Microsurgical Anatomy of the Donor Arteries for Extracranial–Intracranial Bypass Surgery: An Anatomic and Radiologic Study

Satoshi Matsuo
1   Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
,
Noritaka Komune
2   Department of Otorhinolaryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
,
Osamu Akiyama
3   Department of Neurosurgery, Juntendo University, Tokyo, Japan
,
Daisuke Hayashi
1   Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
,
Toshiyuki Amano
1   Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
,
Akira Nakamizo
1   Department of Neurosurgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2019 (online)

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Objective: Extracranial–intracranial (EC-IC) bypass surgery is an important treatment technique for certain ischemic diseases, complex aneurysms, and tumors. This study was performed to review the microsurgical anatomy of the donor arteries for EC-IC bypass, including the superficial temporal artery (STA), occipital artery (OA), and maxillary artery (MA).

Methods: Six cadaveric specimens were dissected to show the relationships between each artery and its surrounding structures at the University of Florida. Nineteen computed tomography angiography images of Japanese adult patients (38 sides) were analyzed to examine the course of each artery and to measure the diameters and distances from various anatomical landmarks to each artery.

Results: The courses of the STA, OA, and MA, which should be exposed during revascularization procedures, were displayed via cadaver dissection with special reference to the following relationships to surrounding structures: STA–soft tissue layers of the temporoparietal region and facial nerve, OA–suboccipital muscles, and MA–mandibular and maxillary nerves.

The STA bifurcated 18.4 mm (range, −16.7 to 50.3 mm) above the superior margin of the zygomatic arch. The inner diameter of the STA was 1.6 ± 0.5 mm at the superior margin of the zygomatic arch, and that of the frontal and parietal branches was 1.2 ± 0.5 and 1.0 ± 0.3 mm, respectively.

All of the OA coursed medial to the posterior belly of the digastric muscle, below the splenius capitis muscle, and above the semispinalis capitis muscle. Six of the 38 OAs coursed above the longissimus capitis muscle. The diameter of the OA at the end of the digastric groove and suboccipital segment was 2.1 ± 0.3 and 1.3 ± 0.4 mm, respectively.

In contrast to the STA and OA, the MA coursed into deeper regions (the infratemporal and pterygopalatine fossae). The pterygoid and pterygopalatine segments of the MA had close relationships with the maxillary and mandibular nerves and their branches, respectively. Three of the 38 MAs coursed medial to the superficial aspect of the pterygoid muscle. The diameter of the proximal pterygoid and pterygopalatine segments of the MA was 2.6 ± 0.5 and 2.0 ± 0.4 mm, respectively.

Conclusion: A precise understanding of the anatomical characteristics of donor arteries and their relationships with surrounding structures will provide safe access to these arteries. Additionally, this reinvestigation of the microsurgical anatomy of the STA, OA, and MA will benefit surgeons who perform surgical procedures involving these vessels.