Microsurgical Techniques for Exposing the Internal Maxillary Artery in Cerebral Revascularization Surgery: A Comparative Cadaver Study

Xiong Li; Atakan Orscelik; Vera Vigo; Olivia Kola; Ivan H El-Sayed; Adib A Abla; Roberto Rodriguez Rubio

doi:10.1016/j.wneu.2020.07.112

Microsurgical Techniques for Exposing the Internal Maxillary Artery in Cerebral Revascularization Surgery: A Comparative Cadaver Study

World Neurosurg. 2020 Nov:143:e232-e242. doi: 10.1016/j.wneu.2020.07.112. Epub 2020 Jul 24.

Authors

Xiong Li¹, Atakan Orscelik², Vera Vigo³, Olivia Kola³, Ivan H El-Sayed⁴, Adib A Abla³, Roberto Rodriguez Rubio⁵

Affiliations

¹ Department of Neurosurgery, Bei Jing Chao Yang Hospital, Capital Medical University, Beijing, China; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
² Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
³ Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA.
⁴ Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA.
⁵ Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA; Department of Neurological Surgery, University of California, San Francisco, California, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, USA. Electronic address: neurodriguez@gmail.com.

PMID: 32712407
DOI: 10.1016/j.wneu.2020.07.112

Abstract

Background: The internal maxillary artery (IMAX) is currently considered one of the main donor vessels in extracranial-to-intracranial bypass surgeries. Four main techniques for harvesting the IMAX have been described: via the anterior medial infratemporal fossa (AMITF), the middle infratemporal fossa (MITF), the anterior lateral middle fossa (ALMF), and the lateral middle fossa (LMF). The advantages and limitations of these techniques have not yet been systematically evaluated and compared.

Methods: Twenty-five cadaver specimens were used to evaluate the harvesting technique. The length and the caliber of the targeted IMAX segments, as well as the depth from the operating plane to the IMAX, surgical time, and surgical area of exposure, were analyzed.

Results: The MITF technique provided the greatest operating area of exposure (mean, 3.88 ± 0.97 cm²). The LMF and MITF techniques provided the largest IMAX caliber (mean, 3.1 ± 0.4 mm and 3.0 ± 0.3 mm, respectively). The ALMF technique provided the shallowest operative depth as well as the least time of exposure (21.8 minutes). The MITF technique exposed the longest IMAX segment (mean, 18.8 ± 3.5 mm).

Conclusions: Advantages of the AMITF and MITF techniques include anatomic simplicity, absence of skull base drilling, and greater discretion in muscle dissection. These properties can simplify the anastomosis procedure compared with the ALMF and LMF techniques. Identification of the IMAX pattern is important before selecting the approach for this bypass operation.

Keywords: Cerebral revascularization; Donor; Exposure techniques; Infratemporal fossa; Internal maxillary artery; Middle fossa.

Publication types

Comparative Study

MeSH terms

Cadaver
Cerebral Revascularization / methods*
Cranial Fossa, Middle
Craniotomy
Humans
Infratemporal Fossa
Maxillary Artery / transplantation*
Microsurgery / methods*
Neurosurgical Procedures / methods