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Microsurgical Techniques for Exposing the Internal Maxillary Artery in Cerebral Revascularization Surgery: A
Xiong Li1, Atakan Orscelik2, Vera Vigo3
1Department of Neurosurgery, Bei Jing Chao Yang Hospital, Capital Medical University, Beijing, China; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
The middle infratemporal fossa (MITF) technique offers the largest exposure area and longest internal maxillary artery (IMAX) segment for bypass surgery. This method, along with the anterior medial infratemporal fossa (AMITF) approach, simplifies procedures compared to other harvesting techniques.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Anatomy
Background:
- The internal maxillary artery (IMAX) is a key donor vessel for extracranial-to-intracranial bypass surgery.
- Four primary harvesting techniques exist: AMITF, MITF, ALMF, and LMF.
- A systematic comparison of these techniques' advantages and limitations is lacking.
Purpose of the Study:
- To systematically evaluate and compare the four main techniques for harvesting the internal maxillary artery (IMAX).
- To analyze key surgical parameters including vessel length, caliber, operative depth, surgical time, and exposure area.
Main Methods:
- Utilized 25 cadaver specimens for evaluating IMAX harvesting techniques.
- Analyzed IMAX segment length and caliber.
- Measured operative depth, surgical time, and surgical area of exposure for each technique.
Main Results:
- The MITF technique yielded the largest exposure area (3.88 cm²) and longest IMAX segment (18.8 mm).
- LMF and MITF techniques provided the largest IMAX caliber (3.1 mm and 3.0 mm, respectively).
- The ALMF technique offered the shallowest depth and shortest surgical time (21.8 minutes).
Conclusions:
- AMITF and MITF techniques offer advantages like anatomic simplicity and reduced need for skull base drilling.
- These simpler approaches may facilitate the anastomosis procedure compared to ALMF and LMF.
- Understanding IMAX anatomy is crucial for selecting the optimal bypass approach.
