Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Exposure of the Maxillary Artery

Yağmurlu, Kaan; Kalani, M. Yashar S.; Martirosyan, Nikolay L.; Safavi–Abbasi, Sam; Belykh, Evgenii; Laarakker, Avra S.; Nakaji, Peter; Zabramski, Joseph M.; Preul, Mark C.; Spetzler, Robert F.

doi:10.1016/j.wneu.2016.12.130

Cited by 31 publications

(10 citation statements)

References 18 publications

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“…Both points are clearly identifiable regardless of condylar shape and volume. The center of the middle meningeal artery was also a reference point, such that variation in vessel diameter [12,32,33] and branching pattern [34][35][36] were not factors. The distance between the maxillary artery and condylar process was measured in the plane running through the deepest point of the mandibular notch, because that plane is easy to identify.…”

Section: Discussionmentioning

confidence: 99%

“…Several imaging studies have described the close relationships between the maxillary and middle meningeal arteries and osseous structures [7][8][9][10][11][12]. However, the minimal distances between these structures remain difficult to predict for an individual patient; at present, it is not possible to generally delimit a safe surgical region.…”

Section: Introductionmentioning

confidence: 99%

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Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography

Schönegg

Ferrari

Ebner

et al. 2021

Oral Maxillofac Surg

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Purpose The close topographic relationship between vascular and osseous structures in the condylar and subcondylar region and marked variability in the arterial course has been revealed by both imaging and cadaveric studies. This study aimed to verify the previously published information in a large sample and to determine a safe surgical region. Methods We analyzed the three-dimensional time-of-flight magnetic resonance angiography images of 300 individuals. Results The mean distance between the middle meningeal artery and the apex of the condyle or the most medial point of the condyle was 18.8 mm (range: 11.2–25.9 mm) or 14.5 mm (range: 8.8–22.9 mm) respectively. The course of the maxillary artery relative to the lateral pterygoid muscle was medial in 45.7% of cases and lateral in 54.3%. An asymmetric course was evident in 66 patients (22%). The mean distance between the maxillary artery and condylar process at the deepest point of the mandibular notch was 6.2 mm in sides exhibiting a medial course (range: 3.7–9.8 mm) and 6.6 mm in sides exhibiting a lateral course (range: 3.9–10.4 mm). The distances were significantly influenced by age, gender, and the course of the maxillary artery. Conclusion Our study emphasizes the marked inter- and intra-individual variability of the maxillary and middle meningeal arterial courses. We confirmed the proximity of the arteries to the condylar process. Extensive surgical experience and thorough preparation for each individual case are essential to prevent iatrogenic vascular injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography

Schönegg

Ferrari

Ebner

et al. 2021

Oral Maxillofac Surg

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“…Furthermore, this technique provides a minimal-invasive route to harvest the MMA as a donor for extracranial-intracranial arterial bypass. 33,34 The purely cadaveric design of the study with the postmortem changes of the tissues may be one of the study limitations. The small number of the examined specimens were free from ITF and skull base abnormalities.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic-Assisted Lateral Corridor to the Infratemporal Fossa: Proposal and Quantitative Comparison to the Endoscopic Transpterygoid Approach

Yacoub

Schneider

Ali

et al. 2019

J Neurol Surg B Skull Base

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Objectives This study was aimed to propose an expanded endoscopic-assisted lateral approach to the infratemporal fossa (ITF) and compare its area of exposure and surgical freedom with the endoscopic endonasal transptergyoid approach (EETA). Methods Anatomical dissections were performed in five cadaver heads (10 sides). The ITF was first examined through the endoscopically assisted lateral corridor, herein referred to as the endoscopic-assisted transtemporal fossa approach (TTFA). After that, the EETA was performed and coupled with two sequential maxillary procedures (medial maxillectomy [MM], and endoscopic-assisted Denker's approach [DA]). Using the stereotactic neuronavigation, measurements of the area of exposure and surgical freedom at the foramen ovale were determined for the previously mentioned approaches. Results Bimanual exploration of the ITF through the endoscopic-assisted lateral approach was achieved in all specimens. The DA (729 ± 49 mm2) provided a larger area of exposure than MM (568 ± 46 mm2; p < 0.0001). However, areas of exposure were similar between the DA and the TTFA (677 ± 35 mm2; p = 0.09). The surgical freedom offered by the TTFA (109.3 ± 19 cm2) was much greater than the DA (24.7 ± 4.8 cm2; p < 0.0001), and the MM (15.2 ± 3.2 cm2, p < 0.0001). Conclusion The study demonstrates the feasibility of the proposed approach to provide direct access to the extreme extensions of the ITF. The lateral corridor offers an ideal working area in the posterior compartment of the ITF without crossing over important neurovascular structures. The new technique may be used alone in selected primary ITF lesions or in combination with endonasal approaches in pathologies spreading laterally from the nose or nasopharynx.

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“…Recently, a less invasive method without bone sacrifice to identify I 2 was proposed. 19,21,39 Meanwhile, new bone landmarks to locate I 2 in a simpler and more efficient way were also introduced by conducting surgical simulation in cadavers. However, we should keep in mind that the working space on a fixed cadaver head is wider than that of a live patient because cadaver tissue is stiff and atrophied.…”

Section: The Role Of Ima Bypass In Cerebral Revascularizationmentioning

confidence: 99%

“…38 Notably, the only clinical case presented by the investigators had received 2 previous procedures, and the middle fossa had been partially removed before IMA bypass. 39 Therefore, this is not the truly minimally invasive IMA bypass operation as defined. Meanwhile, regarding the issues of severe postoperative pain and chewing difficulties, no patient complained of fullness and discomfort of the temporal region in the current study.…”

Section: The Role Of Ima Bypass In Cerebral Revascularizationmentioning

confidence: 99%

Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

Wang

Cai

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).METHODSAll IMA bypasses performed between January 2010 and July 2018 in a single-center, single-surgeon practice were screened.RESULTSIn total, 12 patients (9 males, 3 females) with CMCAAs managed by high-flow IMA bypass were identified. The mean size of CMCAAs was 23.7 mm (range 10–37 mm), and the patients had a mean age of 31.7 years (range 14–56 years). The aneurysms were proximally occluded in 8 cases, completely trapped in 3 cases, and completely resected in 1 case. The radial artery was used as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n = 10), and all aneurysms were completely eliminated (83.3%, n = 10) or greatly diminished (16.7%, n = 2) from the circulation. Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and 1 patient presenting with subarachnoid hemorrhage achieved improved modified Rankin Scale scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 of the 12 patients experienced unremarkable outcomes. The mean interval time from bypass to angiographic and clinical follow-up was 28.7 months (range 2–74 months) and 53.1 months (range 19–82 months), respectively. Although 2 grafts remained occluded, all aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.CONCLUSIONSThe satisfactory result in the present study demonstrated that IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium. However, cases with intraoperative radical resection or inappropriate bypass recipient selection such as aneurysmal wall should be meticulously chosen with respect to the subtype of MCA aneurysm.

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Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Exposure of the Maxillary Artery

Cited by 31 publications

References 18 publications

Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography

Proximity of the middle meningeal artery and maxillary artery to the mandibular head and mandibular neck as revealed by three-dimensional time-of-flight magnetic resonance angiography

Endoscopic-Assisted Lateral Corridor to the Infratemporal Fossa: Proposal and Quantitative Comparison to the Endoscopic Transpterygoid Approach

Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

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