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

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

doi:10.1016/j.wneu.2020.07.112

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…Generally, the second and third segments of IMA, namely the pterygoid and the Pterygopalatine segments, are used as bypass donor arteries ( 17 , 18 ). To better obtain IMA, there have been numerous reports exploring more appropriate approaches and craniotomy techniques to expose IMA in recent years ( 19 – 21 ). Considering the operating space required for bypass surgery, we agree with the experience of Professor Xiang'en Shi's team at Beijing Sanbo Brain Hospital ( 9 , 10 , 22 ), Zygomatic arch was removed and the skull base bone was bitten off when necessary to fully expose the inferior temporal fossa during craniotomy so that the pterygoid segment of IMA can be fully separated.…”

Section: Discussionmentioning

confidence: 99%

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

et al. 2022

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BackgroundChildren's complex middle cerebral artery (MCA) aneurysm is a relatively rare occurrence. When the huge aneurysm is located in the MCA bifurcation with an inconspicuous neck and involving numerous arteries, intravascular interventional surgery or aneurysm clipping are often difficult treatment options. At this point, high flow bypass revascularization is necessary as a treatment to preserve cerebral blood flow. In recent years, the internal maxillary artery (IMA) has gradually become the mainstream donor artery of thw high flow bypass. We performed internal maxillary artery -radial artery-middle cerebral artery (IMA-RA-MCA) and superficial temporal artery-middle cerebral artery (STA-MCA) bypass as the treatment of a complex MCA bifurcation aneurysm in consideration of the patient's condition and the advantage of the IMA. According to the author, this case is the youngest reported case of IMA-RA-MCA bypass at present.Case DescriptionA male child, 7 years and 8 months, was admitted to the hospital due to “recurrent headache for more than 9 months,” DSA indicated that there was a large wide-necked aneurysm at the bifurcation of the right MCA M1 segment, with a size of about 1.16*1.58*1.32 cm. The inflow path of the aneurysm was in front of M1 bifurcation, and one outflow path originated from the aneurysm body, and another small outflow path attached to the aneurysm body. After completing the preoperative evaluation, an extended pterional approach with zygomatic osteotomy was performed to fully expose the aneurysm and IMA, harvesting the left radial artery at the same time, then a STA-MCA bypass, IMA-RA-MCA bypass, and aneurysm trapping were performed. postoperative re-examination showed that bypass vessels and the distal middle artery vessels were patent and the aneurysm disappeared, the child has no neurological dysfunction.ConclusionsIMA-RA-MCA bypass is an effective high-flow cerebral blood reconstruct scheme in the treatment of complex middle cerebral artery bifurcation aneurysms. This case can provide a reference for the surgical treatment of complex middle cerebral artery bifurcation aneurysms in children.

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Section: Discussionmentioning

confidence: 99%

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

et al. 2022

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“…5 If the IMA can be cut, it provides a longer donor vessel. 13 The IMA exhibits a superficial or deep course based on its position superficially to the LPM. 3,14 Alvernia et al found that the IMA had a superficial course in 57.1% of cases and a deep course in 42.9% of cases in a western population, according to the relationship of the artery with the LPM.…”

Section: Discussionmentioning

confidence: 99%

Imaging features of internal maxillary artery and extracranial middle meningeal artery and their relationships on head CTA

Hou

et al. 2021

Neuroradiol J

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Background The internal maxillary artery and extracranial middle meningeal artery are vitally important. Anatomical studies of the relationship of between them using computed tomography angiography are rare. Material and methods This study assessed 75 cases involving 150 sides. And the vascular diameters and lengths of the internal maxillary artery and middle meningeal artery were measured using a GE workstation. The distance between the zygomatic arch midpoint and the internal maxillary artery, the angle between the internal maxillary artery and middle meningeal artery were measured, and the middle meningeal artery branch and internal maxillary artery aneurysm were recorded. The internal maxillary artery course classifications were recorded. All of these parameters were statistically analysed. Results Ages ranged from 18 to 72 (average 40.2) years, and there were 30 women (40%, 30/75) and 45 men (60%, 45/75). Internal maxillary artery length from its origin to middle meningeal artery origin was 1.37 ± 0.59 cm. The extracranial middle meningeal artery length was 1.79 ± 0.48 cm. The vessel diameters of internal maxillary artery origin, middle meningeal artery origin, and middle meningeal artery at the skull base were 2.93 ± 0.52 mm, 1.58 ± 0.43 mm, and 1.33 ± 0.43 mm, respectively. Among the 150 sides of internal maxillary artery course type, there were 138 superficial (92%, 138/150) and 12 (8%, 12/150) deep course cases. The angle between the internal maxillary artery and middle meningeal artery was 116.2 ± 35.76°. Conclusions The findings of this study elucidate the imaging features of the internal maxillary artery and extracranial middle meningeal artery and their relationships, which are helpful for the extracranial–intracranial bypass and endovascular treatment via the internal maxillary artery and middle meningeal artery.

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

Cited by 2 publications

References 21 publications

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

Imaging features of internal maxillary artery and extracranial middle meningeal artery and their relationships on head CTA

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