Short Segment Internal Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Extracranial-to-Intracranial Bypass

Abdulrauf, Saleem I.; Sweeney, Justin M.; Mohan, Yedathore S.; Palejwala, Sheri K.

doi:10.1227/neu.0b013e3182093355

Cited by 61 publications

(23 citation statements)

References 19 publications

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“…For patients who have not undergone balloon test occlusion, if somatosensory evoked potentials are available, a loss of signal may indicate hypoperfusion. Emergent bypass is a last resort, but may be performed from the superficial temporal artery to middle cerebral artery (MCA), or if a radial artery graft is available, from petrous ICA to supraclinoid ICA or internal maxillary artery to MCA [1].…”

Section: Complication Avoidancementioning

confidence: 99%

Lateral transzygomatic middle fossa approach and its extensions: Surgical technique and 3D anatomy

Chotai

Kshettry

Petrak

et al. 2015

Clinical Neurology and Neurosurgery

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Section: Complication Avoidancementioning

confidence: 99%

Lateral transzygomatic middle fossa approach and its extensions: Surgical technique and 3D anatomy

Chotai

Kshettry

Petrak

et al. 2015

Clinical Neurology and Neurosurgery

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“…To improve long-term bypass patency and overall postoperative morbidity, adequate blood flow, short graft length, and invasiveness of the surgical technique should be considered [10,24,28]. To this end, the use of internal maxillary artery as a donor vessel with a radial artery interposition graft provides sufficient blood flow with a shorter graft and is a safe and effective technique for the treatment of giant intracranial aneurysms [1,31]. In this series, there were 39 cases of the RA bypass grafts from the IMA to either the MCA or the proximal posterior cerebral artery (PCA).…”

Section: Choice Of Donor and Graft Vesselsmentioning

confidence: 99%

“…We treated patients with giant aneurysms with good results clinically. The use of the internal maxillary artery as a donor vessel with the radial artery graft can potentially improve long-term graft patency in addition to overall postoperative morbidity [1]. The internal maxillary artery has the advantages of being at a shorter distance from the recipient vessels than the ECA and having a larger vessel diameter than the STA.…”

Section: Choice Of Donor and Graft Vesselsmentioning

confidence: 99%

“…When none of these options are effective or when a high flow bypass is necessary, a bypass with a radial artery interposition graft can be used. IC-IC bypasses have become my preferred bypass (1). IC-IC bypasses may be more technically challenging than EC-IC bypasses, but provide solutions for a wide variety of aneurysms and can be tailored to an individual aneurysm's complexity.…”

Section: Commentsmentioning

confidence: 99%

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Management of complex intracranial aneurysms with bypass surgery: a technique application and experience in 93 patients

et al. 2014

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Despite advances in microsurgery and the development of new endovascular techniques, the treatment of complex intracranial aneurysms remains a daunting challenge for neurosurgeons. In the present study, we retrospectively reviewed our experience of bypass surgery in the treatment of 93 cases of complex intracranial aneurysms. A series of 93 consecutive cases of complex intracranial aneurysms were treated with bypass surgery between April 2004 and July 2013. Radial artery (RA) grafts were used in 58 cases, saphenous vein (SV) grafts in 16 cases, and occipital artery (OA) grafts in 6 cases, while the remaining 13 cases were managed with superficial temporal artery (STA) grafts. In this series, the aneurysms were excised after trapping in 32 cases with mass effect and neural compression. Proximal occlusion of the parent artery was performed in 22 cases of fusiform or giant dissecting aneurysms with subsequent retrograde flow to avoid compromise of the perforators nearby. Trapping was performed after bypass surgery in the remaining 39 cases. Postoperative angiographies were performed in 91 patients and patency of the bypass graft and obliteration of the aneurysms were confirmed in 89 patients. Patency of the bypass could not be confirmed in the remaining two patients, of which one presented with cerebral infarction due to graft occlusion, and the other remained asymptomatic. Within 1 month after surgery, 88 patients had good outcome, four patients needed assistance for daily living, and one death occurred due to brainstem infarction. In 77 patients with a mean follow-up of 3.0 years, 72 patients had good outcome, 4 patients needed assistance for daily living, and 1 death occurred unrelated to surgery. Complex intracranial aneurysms present unique therapeutic challenges that require thorough surgical planning, individualized treatment strategies, and refined neurovascular techniques for successful outcome. Proper use of bypass surgery is imperative in preserving the parent artery and its major perforators. The internal maxillary artery, used as a donor in a bypass, is an effective method due to its shorter distance from the recipient vessels and relatively large diameter with resulting higher flow rate.

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“…Abdulrauf et al 1 have recently published a case report of a high flow EC-IC bypass using the internal maxillary artery (IMAX) as the donor vessel and connecting it to the proximal middle cerebral artery (MCA) by means of a RAG through a single craniotomy incision. This technique has many potential advantages over standard high flow bypass procedures.…”

mentioning

confidence: 99%

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

et al. 2011

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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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Short Segment Internal Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Extracranial-to-Intracranial Bypass

Abstract: The advantages of this new technique include the avoidance of a long cervical incision and potentially higher patency rates secondary to shorter graft length than currently practiced.

Cited by 61 publications

References 19 publications

Lateral transzygomatic middle fossa approach and its extensions: Surgical technique and 3D anatomy

Lateral transzygomatic middle fossa approach and its extensions: Surgical technique and 3D anatomy

Management of complex intracranial aneurysms with bypass surgery: a technique application and experience in 93 patients

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

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