Radial Artery Graft for Bypass of the Maxillary to Proximal Middle Cerebral Artery: An Anatomic and Technical Study

Üstün, Mehmet Erkan; Büyükmumcu, Mustafa; Ülkü, Çağatay Han; Çiçekcibaşı, Aynur Emine; Arbağ, Hamdi

doi:10.1227/01.neu.0000109533.72250.e0

Cited by 41 publications

(6 citation statements)

References 32 publications

(39 reference statements)

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“…Parity in caliber between the recipient or donor vessels and the graft used should be taken into consideration when the choice of revascularization strategy is made because a caliber mismatch not only increases the difficulty of anastomosing but also leads to graft failure due to turbulent flow at the anastomotic site, as obzserved in a saphenous vein graft. Our cadaveric results showed the mean ID of the internal maxillary artery before the infraorbital artery to be 2.60 ± 0.30 mm, and other authors have reported that it ranged from 2.54 to 2.60 mm, comparing favorably with our clinical results. These results suggest that a radial artery graft has a lumen caliber and thickness compared to a saphenous vein graft (mean diameter, 4.81 ± 0.53 mm) for matching the internal maxillary artery and even small‐caliber recipient arteries .…”

Section: Discussionsupporting

confidence: 88%

“…A high‐flow bypass also requires a long cervical incision and 2 surgical fields . Internal maxillary artery–middle cerebral artery and –posterior cerebral artery bypasses, sometimes referred to subcranial–intracranial bypasses, have been introduced as alternatives to conventional extracranial–intracranial bypasses in both cadaveric dissections and clinical microsurgical practice . Unlike a low‐flow bypass, a subcranial–intracranial bypass can produce an immediate substantive increase in flow to the hemisphere.…”

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confidence: 99%

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Measurement of Blood Flow in an Intracranial Artery Bypass From the Internal Maxillary Artery by Intraoperative Duplex Sonography

Shi

Brohi³

et al. 2016

J of Ultrasound Medicine

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This study explored the hemodynamic characteristics of a subcranial-intracranial bypass from the internal maxillary artery by measuring blood flow on intraoperative duplex sonography. The hemodynamic parameters of the internal maxillary artery (n = 20), radial artery (n = 20), internal maxillary artery-middle cerebral artery bypass (n = 42), and internal maxillary artery-posterior cerebral artery bypass (n = 9) were measured by intraoperative duplex sonography. There was no significant difference in the internal diameters of the internal maxillary and radial arteries (mean ± SD, 2.51 ± 0.34 versus 2.56 ± 0.22 mm; P = .648). The mean radial artery graft length for subcranial-intracranial bypasses was 88.5 ± 12.78 mm (95% confidence interval [CI], 80.8-90.2 mm). Internal maxillary artery-middle cerebral artery bypasses required a shorter radial artery graft than internal maxillary artery-posterior cerebral artery bypasses (77.8 ± 2.47 versus 104.8 ± 4.77 mm; P = .001). The mean flow volumes were 85.3 ± 18.5 mL/min (95% CI, 76.6-93.9 mL/min) for the internal maxillary artery, 72.6 ± 26.4 mL/min (95% CI, 64.3-80.9 mL/min) for internal maxillary artery-middle cerebral artery bypasses, and 45.4 ± 6.7 mL/min (95% CI, 40.7-50.0 mL/min) for internal maxillary artery-posterior cerebral artery bypasses. All grafts were opened after the success of the salvage procedures had been established, and the early patency rates (1 month after the operation) were 95% for internal maxillary artery-middle cerebral artery bypasses and 100% the internal maxillary artery-posterior cerebral artery bypasses. Measurement of blood flow by intraoperative sonography can be helpful in decision making and predicting graft patency and success after neurosurgical bypass procedures.

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Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

Measurement of Blood Flow in an Intracranial Artery Bypass From the Internal Maxillary Artery by Intraoperative Duplex Sonography

Shi

Brohi³

et al. 2016

J of Ultrasound Medicine

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“…The diameter of the MA between the end of the pterygoid segment and the pterygopalatine segment at the site of anastomosis has been reported to measure 2.76 mm proximal to the IOA (Büyükmumcu et al, ), 2.4 ± 0.33 mm before the descending palatine artery (Arbag et al, ), and 2.6 ± 0.3 mm before the IOA (Ustün et al, ). The selection of the site of anastomosis as a donor vessel varies by author.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical anatomy of the maxillary artery for extracranial‐intracranial bypass in the pterygopalatine segment of the maxillary artery

et al. 2017

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The extracranial-intracranial (EC-IC) bypass using the maxillary artery (MA) has been successfully completed using a radial artery (RA) graft but the complicated anatomy and narrow exposure make it difficult. The purpose of this article is to define the microsurgical exposure of the MA through the middle fossa and describe the branches, diameter, and length of the MA available for the EC-IC bypass in the sphenopalatine fossa and anterior part of the infratemporal fossa. 5 cadaveric specimens were dissected bilaterally (10 MA dissections) to define the microsurgical anatomy of the MA through an intracranial approach. The exposable branches of the MA at the level of the infratemporal and sphenopalatine fossae were the anterior deep temporal, posterior superior alveolar, and infraorbital arteries. The origin of each branch could be exposed. The available section of the MA for use as a donor vessel is between the origin of the anterior deep temporal artery and the infraorbital artery. The mean exposable length of the MA was 19.4 mm. The mean outer diameter of the donor MA was 3.2 mm. Tension-free EC-IC bypass was possible using a RA graft between the MA and the middle cerebral artery, the MA and the supraclinoid internal carotid artery (ICA), or the MA and the petrous ICA. Exposure of the MA at the infratemporal and sphenopalatine fossae is complicated but provides length and diameter suitable as a donor artery for the EC-IC bypass. Clin. Anat. 31:724-733, 2018. © 2017 Wiley Periodicals, Inc.

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“…The idea of using the IMAX as the donor artery for a high flow EC-IC bypass has been previously proposed by other authors, including Vrionis et al 9 and Ustün et al 10 It has many potential advantages over the standard high flow bypass technique, such as the closer proximity between donor and recipient vessels (which allows a much shorter graft with likely longer graft patency), the ability to perform an EC-IC bypass through a single craniotomy incision, with avoidance of cervical incisions and need for tunneling the graft, improved ease of anastomosis construction using vessels of similar caliber (IMAX-RAG-MCA), and the possibility of making this procedure technically simpler to perform.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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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 latexinjected 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.

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Radial Artery Graft for Bypass of the Maxillary to Proximal Middle Cerebral Artery: An Anatomic and Technical Study

Cited by 41 publications

References 32 publications

Measurement of Blood Flow in an Intracranial Artery Bypass From the Internal Maxillary Artery by Intraoperative Duplex Sonography

Measurement of Blood Flow in an Intracranial Artery Bypass From the Internal Maxillary Artery by Intraoperative Duplex Sonography

Microsurgical anatomy of the maxillary artery for extracranial‐intracranial bypass in the pterygopalatine segment of the maxillary artery

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

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