Pterygo-Maxillary Fissure as a Landmark for Localization of Internal Maxillary Artery for Use in Extracranial-Intracranial Bypass

2020 ◽  
Vol 19 (5) ◽  
pp. E480-E486
Author(s):  
Ivo Peto ◽  
Mohsen Nouri ◽  
Siviero Agazzi ◽  
David Langer ◽  
Amir R Dehdashti
Keyword(s):  
Skull Base ◽  
Posterior Wall ◽  
Maxillary Artery ◽  
Anatomical Landmarks ◽  
Internal Maxillary Artery ◽  
Temporal Muscle ◽  
Proximal Stump ◽  
Frontal Process ◽  
Surgical Field ◽  
The Relationship

Abstract BACKGROUND Internal maxillary artery (IMax) is a relatively new donor vessel used in the extracranial-intracranial bypass surgery. However, unfamiliarity and relatively elaborate techniques of its harvest precluded its widespread use. OBJECTIVE To present a simplified technique of IMax harvest based on constant anatomical landmarks without the need of extensive skull-base drilling while providing adequate space for proximal anastomosis. METHODS Cadaveric dissection on 4 cadaveric heads (8 sides) was performed. Zygomatic osteotomy was performed and temporal muscle was dissected off the zygomatic process of the frontal bone and the frontal process of the zygomatic bone and reflected inferiorly into the bony gap created by the zygomatic osteotomy. Posterior wall of the maxilla (PWoM) was palpated. Following PWoM inferiorly leads to pterygo-maxillary fissure (PMF), which is a constant landmark IMax passes through. RESULTS IMax was localized following this technique before its entrance into PMF in every specimen. Proximal dissection was carried on to the exposed adequate length of the vessel. Depending on the relationship with the lateral pterygoid muscle, this might need to be incised to allow for identification of the IMax. After its transection, proximal stump is mobilized superiorly into the surgical field. Clinical application of this technique was demonstrated on an aneurysm case. CONCLUSION Using the palpation of the PWoM as a landmark for localization of PMF facilitates harvesting of IMax without need for extensive skull-base drilling and shortens the time of the surgery.

scholarly journals Pterygopalatine Fossa: Microsurgical Anatomy and its Relevance for Skull Base Surgery

2020 ◽  
Author(s):  
Gustavo Rassier Isolan ◽  
Julio Mocellin Bernardi ◽  
João Paulo Mota Telles ◽  
Nícollas Nunes Rabelo ◽  
Eberval Gadelha Figueiredo
Keyword(s):  
Skull Base ◽  
The Body ◽  
Pterygopalatine Fossa ◽  
Surgical Approaches ◽  
Maxillary Artery ◽  
Microsurgical Anatomy ◽  
Extensive Resection ◽  
Maxillary Nerve ◽  
Adjacent Structures ◽  
Surgical Field

Abstract Introduction The purpose of this study was to define the anatomical relationships of the pterygopalatine fossa (PPF) and its operative implications in skull base surgical approaches. Methods Ten cadaveric heads were dissected at the Dianne and M Gazi Yasargil Educational Center MicrosurgicaLaboratory, in Little Rock, AK, USA. The PPF was exposed through an extended dissection with mandible and pterygoid plate removal. Results The PPF has the shape of an inverted cone. Its boundaries are the pterygomaxillary fissure; the maxilla, anteriorly; the medial plate of the pterygoid process, and greater wing of the sphenoid process, posteriorly; the palatine bone, medially; and the body of the sphenoid process, superiorly. Its contents are the maxillary division of the trigeminal nerve and its branches; the pterygopalatine ganglion; the pterygopalatine portion of the maxillary artery (MA) and its branches; and the venous network. Differential diagnosis of PPF masses includes perineural tumoral extension along the maxillary nerve, schwannomas, neurofibromas, angiofibromas, hemangiomas, and ectopic salivary gland tissue. Transmaxillary and transpalatal approaches require extensive resection of bony structures and are narrow in the deeper part of the approach, impairing the surgical vision and maneuverability. Endoscopic surgery solves this problem, bringing the light source to the center of the surgical field, allowing proper visualization of the surgical field, extreme close-ups, and different view angles. Conclusion We provide detailed information on the fossa's boundaries, intercommunications with adjacent structures, anatomy of the maxillary artery, and its variations. It is discussed in the context of clinical affections and surgical approaches of this specific region, including pterygomaxillary disjunction and skull base tumors.

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

2021 ◽  
pp. 197140092110193
Author(s):  
Tiefeng Ji ◽  
Kun Hou ◽  
Chao Li ◽  
Jinlu Yu
Keyword(s):  
Artery Aneurysm ◽  
Middle Meningeal Artery ◽  
Maxillary Artery ◽  
Imaging Features ◽  
Internal Maxillary Artery ◽  
Anatomical Studies ◽  
Relationship Of ◽  
The Relationship ◽  
Artery Branch ◽  
Meningeal Artery

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.

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

2016 ◽  
Vol 36 (2) ◽  
pp. 439-447 ◽  
Author(s):  
Zaitao Yu ◽  
Xiang'en Shi ◽  
Shams Raza Brohi ◽  
Hai Qian ◽  
Fangjun Liu ◽  
...  
Keyword(s):  
Blood Flow ◽  
Artery Bypass ◽  
Duplex Sonography ◽  
Maxillary Artery ◽  
Intracranial Artery ◽  
Internal Maxillary Artery

Forearm Cephalic Vein Graft for Short, “Middle”-Flow, Internal Maxillary Artery to Middle Cerebral Artery Bypass

2015 ◽  
Vol 12 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Erez Nossek ◽  
Peter D Costantino ◽  
David J Chalif ◽  
Rafael A Ortiz ◽  
Amir R Dehdashti ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Artery Bypass ◽  
Cephalic Vein ◽  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Vein Grafts ◽  
Graft Length

Abstract BACKGROUND The cervical carotid system has been used as a source of donor vessels for radial artery or saphenous vein grafts in cerebral bypass. Recently, internal maxillary artery to middle cerebral artery bypass has been described as an alternative, with reduction of graft length potentially correlating with improved patency. OBJECTIVE To describe our experience using the forearm cephalic vein grafts for short segment internal maxillary artery to middle cerebral artery bypasses. METHODS All vein grafts were harvested from the volar forearm between the proximal cubital fossa where the median cubital vein is confluent with the cephalic vein and the distal wrist. RESULTS Six patients were treated with internal maxillary artery to middle cerebral artery bypass. In 4, the cephalic vein was used. Postoperative angiography demonstrated good filling of the grafts with robust distal flow. There were no upper extremity vascular complications. All but 1 patient (mortality) tolerated the procedure well. The other 3 patients returned to their neurological baseline with no new neurological deficit during follow-up. CONCLUSION The internal maxillary artery to middle cerebral artery “middle” flow bypass allows for shorter graft length with both the proximal and distal anastomoses within the same microsurgical field. These unique variable flow grafts represent an ideal opportunity for use of the cephalic vein of the forearm, which is more easily harvested than the wider saphenous vein graft and which has good match size to the M1/M2 segments of the middle cerebral artery. The vessel wall is supple, which facilitates handling during anastomosis. There is lower morbidity potential than utilization of the radial artery. Going forward, the cephalic vein will be our preferred choice for external carotid-internal carotid transplanted conduit bypass.

The position of the internal maxillary artery and its questionable relation to the cephalic index

1951 ◽  
Vol 109 (1) ◽  
pp. 119-126 ◽  
Author(s):  
Gabriel Ward Lasker ◽  
Donald Lloyd Opdyke ◽  
Howard Miller
Keyword(s):  
Maxillary Artery ◽  
Internal Maxillary Artery ◽  
Cephalic Index

Arteriovenous fistula of the internal maxillary artery in a child: case report

1992 ◽  
Vol 34 (5) ◽  
pp. 460-461 ◽  
Author(s):  
P. Cluzel ◽  
L. Pierot ◽  
M. Jason ◽  
M. Rose ◽  
E. Kieffer ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Maxillary Artery ◽  
Internal Maxillary Artery
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