Maxillary artery to middle cerebral artery bypass: A novel technique for exposure of the maxillary artery.

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Maxillary artery to middle cerebral artery bypass: A novel technique for exposure of the maxillary artery.

World Neurosurg. 2017 Jan 09;:

Authors: Yagmurlu K, Kalani MY, Martirosyan NL, Safavi-Abbasi S, Belykh E, Laarakker AS, Nakaji P, Zabramski JM, Preul MC, Spetzler RF

Abstract
OBJECTIVES: Define the maxillary artery (MaxA) anatomy and present a novel technique for exposing and preparing this vessel as a bypass donor.
METHODS: Cadaveric and radiological studies were used to define the MaxA anatomy and illustrate a novel method for harvesting and preparing it for extracranial-to-intracranial bypass.
RESULTS: The MaxA runs parallel to the frontal branch of the superficial temporal artery (STA) and is located on average 24.8±3.8 mm inferior to the midpoint of the zygomatic arch. The pterygoid segment of the MaxA is most appropriate for bypass with a maximal diameter of 2.5±0.4 mm. The pterygoid segment can be divided into a main trunk and terminal part based on anatomical features and usage in the bypass procedure. The main trunk of the pterygoid segment can be reached extracranially, either by following the deep temporal arteries downward toward their origin from the MaxA or by following the sphenoid groove downward to the terminal part of the pterygoid segment, which can be followed proximally to expose the entire MaxA. In comparison, the pre-bifurcation diameter of the STA is 1.9±0.5 mm. The average lengths of the mandibular and pterygoid MaxA segments are 6.3±2.4 and 6.7±3.3 mm, respectively.
CONCLUSION: The MaxA can be exposed without zygomatic osteotomies or resection of the middle fossa floor. Anatomical landmarks for exposing the MaxA include the anterior and posterior deep temporal arteries and the pterygomaxillary fissure.

PMID: 28089839 [PubMed - as supplied by publisher]

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