The maxillary artery as a recipient vessel option for complex midface and anterior skull base microsurgical repair: A cadaveric study

Systematic review and meta-analysis of the anatomy of the maxillary artery using the Anatomical Quality Assurance (AQUA) checklist

BACKGROUND

The maxillary artery (MA) is one of the terminal branches of the external carotid artery (ECA) and through its branches, it is responsible for vascularizing several organs and muscles of the head and neck, including their surrounding soft tissues, the oral and sinonasal cavities, dura mater, and various cranial nerves. The aim of this study was to conduct a systematic review and meta-analysis of maxillary artery anatomy according to the Anatomical Quality Assurance (AQUA) checklist.

METHODS

We conducted a systematic search through PubMed, EMBASE, Scopus, ScienceDirect, Web of Science, SciELO, Springerlink, WILEY and BIREME databases. We applied the Anatomical Quality Assurance (AQUA) checklist for analysis the methodological quality of the articles.

RESULTS

From a total of 11,759 articles found in the first search, and after applying the inclusion/exclusion criteria, in addition to eliminating duplicate articles, a final number of 24 articles were identified. The information on the maxillary artery was analyzed from each study regarding its course in relation to the lateral pterygoid muscle, the intra- and extraluminal diameters of the maxillary artery and its branches, and the types of branching of the maxillary artery in the pterygopalatine fossa.

CONCLUSION

From this study, it was possible to conclude the importance of anatomical knowledge of the maxillary artery, for its application in the clinical study of the head and neck, as well as the need to apply the AQUA checklist in the development of systematic anatomical reviews to ensure accurate reliability and a better assessment of the effect of anatomical publications.

Angio-anatomical study of the pterygovaginal artery based on cone-beam computed tomography

PURPOSE

To investigate the anatomical characteristics and clinical implications of the pterygovaginal artery (PtVA), a recurrent branch from the distal internal maxillary artery (IMA), which courses through the pterygovaginal canal that connects the pterygopalatine fossa and nasopharynx.

METHODS

Eighty-two patients with 90 sides of cone-beam computed tomography (CBCT) reconstructed from rotational angiography of the external or common carotid artery with a field of view covering the pterygopalatine fossa were retrospectively reviewed. The origin from the IMA, branching type, distribution, and anastomoses was evaluated. The underlying lesions were 36 hypervascular lesions with possible supply from PtVA (17 cavernous sinus arteriovenous fistulas (AVFs), 6 anterior condylar AVFs, and 13 nasopharyngeal, parasellar, or paraclival tumors) and 46 other diseases.

RESULTS

PtVA was identified in 75 sides (83%). It originated from the pterygopalatine segment of the IMA in 45 sides (60%) and from the pterygoid segment in 30 sides (40%). It arose independently (77%), sharing the common trunk with the Vidian artery (15%) or with other branches. It ran posteromedially through the pterygovaginal canal to supply the mucosa over the nasopharyngeal roof, the choanae, and the pharyngeal ostium of the eustachian tube. It anastomosed with the ascending pharyngeal artery (n=37), the accessory meningeal artery (n=7), and the mandibular artery from the petrous internal carotid artery (n=2). It served as a feeder of osseous AVFs and skull base tumors.

CONCLUSION

PtVA was often identified by CBCT even in normal anatomy. Its detailed angio-anatomy could be evaluated in the presence of parasellar or paraclival hypervascular lesions.

Pedicle Corridors and Vessel Options for Free Flap Reconstruction following Endoscopic Endonasal Skull Base Surgery: A Systematic Review

Introduction  Microvascular free flaps offer an alternative to local and regional flaps for coverage of complex or large skull base defects. Routes and approaches to these reconstructive options are complicated and require an understanding of complex head and neck anatomy. Methods  A systematic review of the literature was performed using a set of search terms with the help of a qualified librarian. Articles were reviewed and selected for inclusion based on relevance. We were interested in reporting possible routes for free flap accessibility to the skull base as well as microvascular vessel options, as this choice may affect the geometry and accessibility to the defect. Results  A total of 1,917 articles were obtained from a comprehensive search and 11 articles were ultimately found to be relevant to this review. Published options for vessel anastomosis and corridors to the skull base following endoscopic endonasal surgery are reviewed, including Caldwell-Luc/transbuccal space, prevertebral space, transpterygoid/parapharyngeal, and transmaxillary approaches. Conclusion  The field of endoscopic surgery has continued to advance and provide options for tumors of the skull base. This has led to a need for creative routes to the skull base for free flap reconstruction.

The History and Evolution of Internal Maxillary Artery Bypass

Internal maxillary artery (IMA) bypass has gained momentum in the last 5 years for the treatment of complex cerebrovascular disorders and skull base tumors. However, some issues regarding this treatment modality have been proposed. As one of the most experienced neurosurgical teams to perform internal maxillary artery bypass in the world (>100 clinical cases), we reviewed the literature in aspects of basic anatomy of maxillary artery with its variations to the lateral pterygoid muscle, initial anastomosis modalities, and subsequent exposure techniques in cadaver studies, preoperative arterial evaluation methods, optimal interposed graft selections, and surgical outcome in the management of complex aneurysms, skull base tumors, and steno-occlusive disorders.