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Kartum TA, Aydin L, Vergili E, Tahmazoglu B, Dağlar Z, Küçükyürük B, Tanriover N. Localization of Maxillary Artery for Cerebral Revascularization: L-Shaped Perpendicular Two-Step Drilling Technique Stretching from the Foramen Ovale to Rotundum. World Neurosurg 2024; 185:e1101-e1113. [PMID: 38508387 DOI: 10.1016/j.wneu.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The use of the maxillary artery (MA) as a donor has increasingly become an alternative method for cerebral revascularization. Localization difficulties emerge due to rich infratemporal anatomical variations and the complicated relationships of the MA with neuromuscular structures. We propose an alternative localization method via the interforaminal route along the middle fossa floor. METHODS Five silicone-injected adult cadaver heads (10 sides) were dissected. Safe and effective localization of the MA was evaluated. RESULTS The MA displayed anatomical variations in relation to the lateral pterygoid muscle (LPM) and the mandibular nerve branches. The proposed L-shaped perpendicular 2-step drilling technique revealed a long MA segment that allowed generous rotation to the intracranial area for an end-to-end anastomosis. The first step of drilling involved medial-to-lateral expansion of foramen ovale up to the lateral border of the superior head of the LPM. The second step of drilling extended at an angle approximately 90° to the initial path and reached anteriorly to the foramen rotundum. The MA was localized by gently retracting the upper head of the LPM medially in a posterior-to-anterior direction. CONCLUSIONS Considering all anatomical variations, the L-shaped perpendicular 2-step drilling technique through the interforaminal space is an attainable method to release an adequate length of MA. The advantages of this technique include the early identification of precise landmarks for the areas to be drilled, preserving all mandibular nerve branches, the deep temporal arteries, and maintaining the continuity of the LPM.
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Affiliation(s)
- Tufan Agah Kartum
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Levent Aydin
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ender Vergili
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Burak Tahmazoglu
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zeynep Dağlar
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Barış Küçükyürük
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necmettin Tanriover
- Microsurgical Neuroanatomy Laboratory, Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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Degollado-García J, Casas-Martínez MR, Mejia BRF, Balcázar-Padrón JC, Rodríguez-Rubio HA, Nathal E. Internal maxillary artery (IMax) - middle cerebral artery bypass in a patient with bilateral atherosclerotic carotid occlusion: A technical case report. J Cerebrovasc Endovasc Neurosurg 2024; 26:51-57. [PMID: 37997040 PMCID: PMC10995475 DOI: 10.7461/jcen.2023.e2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/21/2023] [Accepted: 05/12/2023] [Indexed: 12/06/2023] Open
Abstract
Since the first description of the possible utilization of the internal maxillary artery for bypass surgery, there are some reports of its use in aneurysm cases; however, there is no information about the possible advantages of this type of bypass for cerebral ischemic disease. We present a 77-year-old man with a history of diabetes, hypertension, systemic atherosclerosis, and two acute myocardial infarctions with left hemiparesis. Imaging studies reported total occlusion of the right internal carotid artery and 75% occlusion on the left side, with an old opercular infarction and repeated transient ischemic attacks in the right middle cerebral artery territory despite medical treatment. After a consensus, we decided to perform a bypass from the internal maxillary artery to the M2 segment of the middle cerebral artery using a radial artery graft. After performing the proximal anastomosis, the calculated graft's free flow was 216 ml/min. Subsequently, after completing the bypass, the patency was confirmed with fluorescein videoangiography and intraoperative Doppler. Postoperatively, imaging studies showed improvement in the perfusion values and the hemiparesis from 3/5 to 4+/5. The patient was discharged one week after the operation, with a modified Rankin scale of 1, without added deficits. The use of revascularization techniques in steno-occlusive disease indicates a select group of patients that may benefit from this procedure. In addition, internal maxillary artery bypass has provided a safe option for large areas of ischemia that cannot be supplied with a superficial temporal artery - middle cerebral artery bypass.
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Affiliation(s)
- Javier Degollado-García
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Martin R. Casas-Martínez
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Bill Roy Ferrufino Mejia
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Juan C. Balcázar-Padrón
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Héctor A. Rodríguez-Rubio
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
| | - Edgar Nathal
- Vascular Neurosurgery Department, National Institute of Neurology and Neurosurgery “Manuel Velasco Suárez”, Mexico City, Mexico
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Oliveira LDB, Cieslak PH, Marques GN, Batista S, Andreão FF, Palavani LB, Bocanegra-Becerra JE, Bertani R, Rabelo NN, Welling LC, Figueiredo EG. Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis. Neurosurg Rev 2024; 47:41. [PMID: 38206429 DOI: 10.1007/s10143-023-02265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024]
Abstract
The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3-53.1). The post-operation patency rate was 99% (95% CI: 97-100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68-96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9-32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0-2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81-96%; I2=0%), and only 3% experienced ischemia (95% CI: 0-6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.
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Affiliation(s)
- Leonardo de Barros Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil.
| | - Pedro Henrique Cieslak
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
| | | | - Sávio Batista
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil
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Li M, Wang X, Li S, Chen G, Ren J, Chen G, Liang J, Bao Y, Sun L. Maxillary Nerve as Landmark for Exposure of the Internal Maxillary Artery in Extracranial-Intracranial Bypass Surgery. World Neurosurg 2023; 175:e406-e412. [PMID: 37011762 DOI: 10.1016/j.wneu.2023.03.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To establish a new method for fast exposure of the internal maxillary artery (IMA) during extracranial-intracranial bypass surgery. METHODS To explore the positional relationship between the IMA and the maxillary nerve and pterygomaxillary fissure, 11 formalin-fixed cadaveric specimens were dissected. Three bone windows of the middle fossa were created for further analysis. Then the IMA length that could be pulled up above the middle fossa was measured after different degrees of removal of bony structure. The IMA branches under each bone window were also explored in detail. RESULTS The top of the pterygomaxillary fissure was located 11.50 mm anterolateral to the foramen rotundum. The IMA could be identified just inferior to the infratemporal segment maxillary nerve in all specimens. After drilling of the first bone window, the IMA length that could be pulled above the middle fossa bone was 6.85 mm. After drilling of the second bone window and further mobilization, the IMA length that could be harvested was significantly longer (9.04 mm vs. 6.85 mm; P < 0.001). Removal of the third bone window did not significantly improve the IMA length that could be harvested. CONCLUSIONS The maxillary nerve could be used as a reliable landmark for the exposure of the IMA in the pterygopalatine fossa. With our technique, the IMA could be easily exposed and sufficiently dissected without zygomatic osteotomy and extensive middle fossa floor removal.
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Affiliation(s)
- Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shenjie Li
- Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guohuan Chen
- Department of Neurosurgery, Yiyang Central Hospital, Yiyang, China
| | - Jian Ren
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liyong Sun
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Erdem H, Cevik Y, Safak NK, Soames RW, Pehlivan UA, Boyan N, Oguz O. Morphometric analysis of the infratemporal fossa using three-dimensional (3D) digital models. Surg Radiol Anat 2023; 45:729-734. [PMID: 37036494 DOI: 10.1007/s00276-023-03144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE The infratemporal fossa contains important neurovascular components and is directly related to other anatomical regions and structures. The morphometric distances between the bones forming its borders have not been thoroughly investigated. The aim of this study was to determine the morphometry of the infratemporal fossa. METHODS 3D models of the skull of 83 individuals were reconstructed from DICOM datasets, from which length, depth and width measurements were determined and compared between genders and the right and left sides. RESULTS All measurements obtained were significantly different between males and females. There were also significant differences between the left and right sides for depth and width measurements. CONCLUSION This is the first study to determine and investigate measurements of the infratemporal fossa; as such it provides a comprehensive view of the morphology of the fossa. It provides valuable information for surgical interventions and differential diagnoses of pathologies in this region, as well as enhancing its understanding in medical education.
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Affiliation(s)
- Huseyin Erdem
- Department of Anatomy, Faculty of Medicine, Cukurova University, 01330, Adana, Turkey.
| | - Yigit Cevik
- Department of Anatomy, Faculty of Medicine, Cukurova University, 01330, Adana, Turkey
| | - Nazire Kilic Safak
- Department of Anatomy, Faculty of Medicine, Cukurova University, 01330, Adana, Turkey
| | - Roger W Soames
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, DD14HN, UK
| | - Umur Anil Pehlivan
- Department of Radiology, Baskent University Hospital Adana, 01330, Adana, Turkey
| | - Neslihan Boyan
- Department of Anatomy, Faculty of Medicine, Cukurova University, 01330, Adana, Turkey
| | - Ozkan Oguz
- Department of Anatomy, Faculty of Medicine, Cukurova University, 01330, Adana, Turkey
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Mongkolkul K, Alsavaf MB, Salem EH, VanKoevering KK, Kelly K, Hardesty DA, Prevedello DM, Carrau RL. Endoscopic Multiport Approach for Exenteration of the Infratemporal Fossa. Laryngoscope 2023; 133:1367-1374. [PMID: 36752574 DOI: 10.1002/lary.30611] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To demonstrate anatomic relationships pertinent to the endoscopic multiport approach to the infratemporal fossa (ITF). Discuss advantages and limitations of each individual approach. STUDY DESIGN Cadaveric study. METHODS Endoscopic and endoscopic-assisted endonasal transpterygoid, sublabial transmaxillary, endoscopic transorbital, and endoscopic transoral approaches to accessing the ITF were completed in five silicone-injected fresh cadaveric specimens (10 sides) with the assistance of 0, 30, and 450 rods-lens endoscopes. Image guidance was used to confirm and document the anatomical relationships encountered in each approach. RESULTS The endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure to median structures. Endoscopic-assisted sublabial transmaxillary approach enhances the field of exposure, angle of attack, and ease of instrumentation to the lateral part of the ITF. Endoscopic-assisted transorbital approach via the inferior orbital fissure provided cephalic and anterior access. Endoscopic-assisted transoral approach complements the access to lesions extending inferior to the hard palate or far lateral to the mandibular condyle. CONCLUSIONS A combination of minimal access infratemporal approaches can provide adequate exposure of the entire ITF while avoiding some of the morbidity associated with open approaches. LEVEL OF EVIDENCE NA Laryngoscope, 2023.
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Affiliation(s)
- Kittichai Mongkolkul
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Excellence Center in Otolaryngology-Head & Neck Surgery Rajavithi Hospital, Bangkok, Thailand.,Department of Otolaryngology-Head & Neck Surgery, Rangsit University College of Medicine, Bangkok, Thailand
| | - Mohammad Bilal Alsavaf
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Eman H Salem
- Department of Otolaryngology-Head & Neck Surgery, Mansoura University Hospitals, Mansoura, Egypt
| | - Kyle K VanKoevering
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Kathleen Kelly
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Douglas A Hardesty
- Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
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Zoli M, Sollini G, Zaccagna F, Fabbri VP, Cirignotta L, Rustici A, Guaraldi F, Asioli S, Tonon C, Pasquini E, Mazzatenta D. Infra-Temporal and Pterygo-Palatine Fossae Tumors: A Frontier in Endoscopic Endonasal Surgery—Description of the Surgical Anatomy of the Approach and Report of Illustrative Cases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116413. [PMID: 35681999 PMCID: PMC9180479 DOI: 10.3390/ijerph19116413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/16/2022]
Abstract
Infratemporal and pterygopalatine fossae (ITF and PPF) represent two complex paramedian skull base areas, which can be defined as jewelry boxes, containing a large number of neurovascular and osteomuscular structures of primary importance. They are in close communication with many craniofacial areas, such as nasal/paranasal sinuses, orbit, middle cranial fossa, and oral cavities. Therefore, they can be involved by tumoral, infective or inflammatory lesions spreading from these spaces. Moreover, they can be the primary site of the development of some primitive tumors. For the deep-seated location of ITF and PPF lesions and their close relationship with the surrounding functional neuro-vascular structures, their surgery represents a challenge. In the last decades, the introduction of the endoscope in skull base surgery has favored the development of an innovative anterior endonasal approach for ITF and PPF tumors: the transmaxillary-pterygoid, which gives a direct and straightforward route for these areas. It has demonstrated that it is effective and safe for the treatment of a large number of benign and malignant neoplasms, located in these fossae, avoiding extensive bone drilling, soft tissue demolition, possibly unaesthetic scars, and reducing the risk of neurological deficits. However, some limits, especially for vascular tumors or lesions with lateral extension, are still present. Based on the experience of our multidisciplinary team, we present our operative technique, surgical indications, and pre- and post-operative management protocol for patients with ITF and PPF tumors.
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Affiliation(s)
- Matteo Zoli
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (S.A.); (D.M.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy; (F.Z.); (V.P.F.); (C.T.)
- Correspondence: ; Tel.: +39-051-622-5514; Fax: +39-051-622-5347
| | - Giacomo Sollini
- ENT Unit, Bellaria Hospital, Azienda Unità Sanitaria Locale, 40133 Bologna, Italy; (G.S.); (E.P.)
| | - Fulvio Zaccagna
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy; (F.Z.); (V.P.F.); (C.T.)
- Programma Neuroimmagini Funzionali e Molecolari, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Viscardo Paolo Fabbri
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy; (F.Z.); (V.P.F.); (C.T.)
| | - Lorenzo Cirignotta
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (L.C.); (A.R.)
| | - Arianna Rustici
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy; (L.C.); (A.R.)
| | - Federica Guaraldi
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (S.A.); (D.M.)
| | - Sofia Asioli
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (S.A.); (D.M.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy; (F.Z.); (V.P.F.); (C.T.)
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy; (F.Z.); (V.P.F.); (C.T.)
- Programma Neuroimmagini Funzionali e Molecolari, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy
| | - Ernesto Pasquini
- ENT Unit, Bellaria Hospital, Azienda Unità Sanitaria Locale, 40133 Bologna, Italy; (G.S.); (E.P.)
| | - Diego Mazzatenta
- Programma Neurochirurgia Ipofisi—Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy; (F.G.); (S.A.); (D.M.)
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40125 Bologna, Italy; (F.Z.); (V.P.F.); (C.T.)
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Yoshida K, Akiyama T, Raz E, Kamamoto D, Ozawa H, Toda M. Angio-anatomical study of the pterygovaginal artery based on cone-beam computed tomography. Neuroradiology 2021; 63:1325-1333. [PMID: 33555352 DOI: 10.1007/s00234-021-02657-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Keisuke Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takenori Akiyama
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Dai Kamamoto
- Department of Neurosurgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Toda
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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9
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Peto I, Nouri M, Agazzi S, Langer D, Dehdashti AR. Pterygo-Maxillary Fissure as a Landmark for Localization of Internal Maxillary Artery for Use in Extracranial-Intracranial Bypass. Oper Neurosurg (Hagerstown) 2020; 19:E480-E486. [PMID: 32585696 DOI: 10.1093/ons/opaa177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 12/26/2022] Open
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.
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Affiliation(s)
- Ivo Peto
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College Of Medicine, Tampa, Florida.,Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Mohsen Nouri
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College Of Medicine, Tampa, Florida
| | - David Langer
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Amir R Dehdashti
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York
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10
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Abstract
BACKGROUND AND OBJECTIVE The aim of the study was to propose a new bony landmark, point O, which is the junction point of the temporosphenoid suture and the infratemporal ridge; this landmark may improve the identification and preservation of neurovascular structures when approaches are used to access the middle cranial fossa in lateral skull base tumor surgeries. METHODS Fifteen cadaveric heads were measured for anatomical analysis. Related surgical landmarks were studied using the Destroscope virtual reality system and during the dissection procedures, and the results were analyzed and compared. RESULTS From the perspective of the middle skull base, the radial lines from point O to the interior point of the superior orbital fissure, foramen rotundum, foramen ovale, and foramen spinosum are approximately equal in length, with an average length of 23.22 mm, and the above 5 points form a sector with an angle of 66.07° and an area of 310.71 mm. CONCLUSIONS Identification of point O as a landmark for lateral skull base surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complicated operations. The interior points of the superior orbital fissure, foramen rotundum, foramen ovale, and foramen spinosum are distributed on the arc of a circle whose center is point O. The sector formed by the above 5 points is not only a crucial area for the communication of lesions between the middle skull base and the infratemporal fossa but also a safe avenue through which to remove skull base lesions.
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11
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Surgical Anatomy of the Donor Arteries for Extracranial-Intracranial Bypass Surgery: An Anatomic and Radiologic Study. World Neurosurg 2020; 136:e447-e459. [DOI: 10.1016/j.wneu.2020.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022]
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12
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Sato H, Nonaka Y, Bawornvaraporn U, Fukushima T. Preauricular retromandibular trans tympanic plate and styloid process keyhole approach to parapharyngeal lesions: a laboratory study. Acta Neurochir (Wien) 2020; 162:661-669. [PMID: 31965319 DOI: 10.1007/s00701-020-04217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The surgical removal of the infratemporal parapharyngeal lesions (IPL) is challenging due to its anatomical complexity. Previous surgical approaches have often been too invasive and necessitated sacrifice of normal function and anatomical structures, particularly in the retromandibular nerve region. Therefore, we sought to identify an approach corridor to this area that requires less sacrifice and report an innovative approach through a retromandibular fossa route to the IPL. METHODS Five cadaveric specimens were dissected bilaterally with a trans-tympanic plate and styloid process approach. These specimens were investigated microanatomically and morphometrically to examine the extent of the approach in the parapharyngeal space. The clinical application of this approach was compared to previous approaches to the IPL used in our clinical series of 20 cases. RESULTS Using this novel approach, the inferior alveolar nerve was identified in all specimens, while the chorda tympani and lingual nerve were identified in 6 (60%) and 4 (40%) dissections, respectively. In all specimens, the petrous portion of the internal carotid artery and the exit of the lower cranial nerve were identified. The average length of the exposed lower cranial nerves was 16.6 ± 3.8 mm (range: 11-25 mm). CONCLUSIONS The described approach is feasible for accessing the IPL at the retromandibular nerve and is less invasive than conventionally used approaches.
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Affiliation(s)
- Hikari Sato
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
- Moriyama Memorial Hospital, 4-3-1 Kitakasai, Edogawa, Tokyo, 134-0081, Japan.
| | - Yoichi Nonaka
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Udom Bawornvaraporn
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Takanori Fukushima
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
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13
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Zaki Ghali G, George Zaki Ghali M, Zaki Ghali E, Lahiff M, Coon A. Clinical utility and versatility of the petrous segment of the internal carotid artery in revascularization. J Clin Neurosci 2020; 73:13-23. [PMID: 31987635 DOI: 10.1016/j.jocn.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 09/03/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
Direct approaches to high cervical lesions, including tumors and aneurysms, carry significant risks. This renders alternative approaches desirable, with vascular disease amenable to exclusion and revascularization to the intracranial circulation, including the petrous or supraclinoid segments of the internal carotid artery (ICA). The cervicopetrous ICA bypass via saphenous venous grafting has proven an effective strategy for treating and excluding these lesions. In current practice, this is performed via an extradural subtemporal approach to access the petrous segment of the ICA and a cervical incision for access to the cervical ICA. The venous graft is alternately tunneled subcutaneously or in situ through the cervical ICA, with the latter eschewing external compression, kinking, and torsion, which increases risk of graft thrombosis with the former. Maxillary or middle meningeal arteries may also serve as donors to the petrous ICA. Moreover, the petrous ICA may be used as a donor in revascularization procedures, to the supraclinoid segment of the ICA and the middle cerebral artery, with petrous supraclinoid and petrous-MCA bypasses described. Clinical utility and operative approaches bypassing to or from the petrous ICA in revascularization procedures are reviewed and discussed.
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Affiliation(s)
- George Zaki Ghali
- United States Environmental Protection Agency, Arlington, VA, United States; Department of Toxicology, Purdue University, West Lafayette, IN, United States
| | - Michael George Zaki Ghali
- Department of Neurological Surgery, Houston Methodist Hospital, Houston, TX, United States; Department of Neurobiology and Anatomy, Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA 19129, United States.
| | - Emil Zaki Ghali
- Department of Medicine, Inova Alexandria Hospital, Alexandria, United States; Department of Urological Surgery, El Gomhoureya General Hospital, Alexandria, Egypt
| | - Marshall Lahiff
- Walton Lantaff Schoreder and Carson LLP, 9350 S Dixie Highway, Miami, FL 33156, United States
| | - Alexander Coon
- Department of Neurosurgery, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, United States
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14
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Zaki Ghali MG, Srinivasan VM, Britz GW. Maxillary Artery to Intracranial Bypass. World Neurosurg 2019; 128:532-540. [DOI: 10.1016/j.wneu.2019.03.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 12/16/2022]
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15
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Rubio RR, Chae R, Abla AA. The Relevance of Surgical Anatomy for Harvesting the Internal Maxillary Artery and Nomenclature of a “New” Bypass Technique. World Neurosurg 2019. [DOI: 10.1016/j.wneu.2018.12.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Rodriguez Rubio R, Kola O, Tayebi Meybodi A, Tabani H, Feng X, Burkhardt JK, Yousef S, Lawton MT, Benet A. Minimally Invasive Exposure of the Maxillary Artery at the Anteromedial Infratemporal Fossa. Oper Neurosurg (Hagerstown) 2019; 16:79-85. [PMID: 29660062 DOI: 10.1093/ons/opy051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The maxillary artery (MA) has been described as a reliable donor for extracranial-intracranial high-flow bypass. Existing techniques to harvest MA require brain retraction and drilling of the middle fossa (with or without a zygomatic osteotomy), carrying the potential risks of venous bleeding, injury to the branches of the maxillary or mandibular nerves, muscular transection, or temporomandibular junction disorders. OBJECTIVE To describe a novel technique to expose the MA without bony drilling and with minimal impact to surrounding structures. METHODS A conventional curvilinear incision was performed in 10 cadaveric specimens, prior to elevating the scalp to expose the zygomatic root and lateral orbital rim. The sphenozygomatic suture was followed to the anterolateral edge of the inferior orbital fissure (IOF) to locate and harvest the pterygoid segment of the MA. Topographic anatomy was assessed using surrounding landmarks and 3D Cartesian coordinates to define the surgical area. The number of visible MA branches and their lengths were recorded. RESULTS The MA was successfully exposed in all specimens. This approach allowed 6 branches of MA to be exposed. The average length of exposure was 23.3 ± 8.3 mm and the average surgical area was 2.8 ± 0.9 cm2. The IOF was 11.5 ± 4.2 mm from the MA. CONCLUSION Our technique provides landmarks to identify the distal pterygoid segment of MA as a donor for extracranial-intracranial bypasses without the need for additional craniectomies. Clear anatomical landmarks, including the sphenozygomatic suture, anterolateral edge of IOF, infraorbital artery, and the pterygomaxillary fissure defined a trajectory to efficiently localize the MA with minimal risk to surrounding structures.
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Affiliation(s)
- Roberto Rodriguez Rubio
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Olivia Kola
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Ali Tayebi Meybodi
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Halima Tabani
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Xuequan Feng
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California.,Department of Neurological Surgery, First Center Hospital, Tianjin, China
| | - Jan-Karl Burkhardt
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Sonia Yousef
- Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Michael T Lawton
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.,Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
| | - Arnau Benet
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona.,Department of Neurological Surgery, University of California, San Francisco, California.,Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California
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17
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Internal Maxillary Artery to Anterior Circulation Bypass with Local Interposition Grafts Using a Minimally Invasive Approach: Surgical Anatomy and Technical Feasibility. World Neurosurg 2018; 120:e503-e510. [PMID: 30149162 DOI: 10.1016/j.wneu.2018.08.113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The internal maxillary artery (IMA) is a reliable donor for extracranial-intracranial high-flow bypasses. However, previously described landmarks and techniques to harvest the IMA are complex and confusing and require extensive bone drilling, carrying significant neurovascular risk. The objective of our study was to describe a minimally invasive technique for exposing the IMA and to assess the feasibility of using the IMA as a donor for anterior-circulation recipient vessels using 2 different local interposition vessels. METHODS Via a minimally invasive technique, the IMA was harvested in 10 cadaveric specimens and a pterional craniotomy was performed. Two interposition grafts-the superficial temporal artery (STA) and middle temporal artery-were evaluated individually. Transsylvian exposure of the second segment of middle cerebral artery (M2), the supraclinoid internal carotid artery, and the proximal postcommunicating anterior cerebral artery segment was completed. Relevant vessel calibers and graft lengths were measured for each bypass model. RESULTS The mean caliber of the IMA was 2.7 ± 0.5 mm. Of all 3 recipients, the shortest graft length was seen in the IMA-STA-M2 bypass, measuring 42.0 ± 8.4 mm. There was a good caliber match between the M2 (2.4 ± 0.4 mm) and STA (2.3 ± 0.4 mm) at the anastomotic site. The harvested middle temporal artery was sufficient in length in only 30% cases, with a mean distal caliber of 2.0 ± 0.7 mm. CONCLUSIONS This study confirmed the technical feasibility of IMA as a donor for an extracranial-intracranial bypass to the second segment of the anterior cerebral artery, M2, and the supraclinoid internal carotid artery. However, IMA-STA-M2 was observed to be the most suitable bypass model.
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18
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Nossek E, Langer DJ. Internal Maxillary Artery to Middle Cerebral Artery Cranial Bypass: The New “Work Horse” for Cerebral Flow Replacement. World Neurosurg 2018; 115:44-46. [DOI: 10.1016/j.wneu.2018.03.214] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 10/17/2022]
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19
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Patwa HS, Yanez-Siller JC, Gomez Galarce M, Otto BA, Prevedello DM, Carrau RL. Analysis of the far-medial transoral endoscopic approach to the infratemporal fossa. Laryngoscope 2018; 128:2273-2281. [PMID: 29729008 DOI: 10.1002/lary.27223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/28/2018] [Accepted: 03/14/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To demonstrate anatomic relationships of the far-medial transoral endoscopic assisted approach (FMT-EAA) to the infratemporal fossa (ITF) and define the corridor dimensions, surgical freedom, and limitations associated with this approach. STUDY DESIGN Cadaveric study. METHODS Twenty ITFs (10 specimens) were dissected with the assistance of 0 °, 30 °, and 45 ° rod-lens endoscopes. Image guidance was used to confirm and measure the corridors' structural boundaries and document the anatomical relationships encountered in this approach. RESULTS Access to the ITF via the FMT-EAA can be divided into two secondary surgical corridors: the superomedial and inferolateral triangles, each of which provides access to different areas. The superomedial triangle is bounded medially by the lateral pterygoid plate and posterolateral maxillary sinus wall, superiorly by the greater sphenoid wing, and inferolaterally by the lateral pterygoid muscle. The inferolateral triangle is bounded superiorly by the lower head of the lateral pterygoid muscle, inferiorly by the medial pterygoid muscle, and laterally by the mandible. Using a standard 19-mm endoscope, the FMT-EAA achieves a mean surgical freedom of 231 mm and 161 mm in the vertical and horizontal planes, respectively. CONCLUSIONS FMT-EAA adequately exposes critical structures of the ITF. This technique is a viable option for the management of selected ITF lesions, either alone or in combination with alternative minimally invasive approaches to the region. LEVEL OF EVIDENCE NA Laryngoscope, 128:2273-2281, 2018.
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Affiliation(s)
- Hafiz S Patwa
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, Wake Forest Baptist Medical Center, Winston Salem, North Carolina, U.S.A
| | - Juan C Yanez-Siller
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
| | - Matias Gomez Galarce
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Otolaryngology, German Hospital of Santiago, Santiago, Chile
| | - Bradley A Otto
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
| | - Daniel M Prevedello
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A.,Department of Neurosurgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, U.S.A
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20
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Abstract
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.
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21
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Akiyama O, Güngör A, Middlebrooks EH, Kondo A, Arai H. Microsurgical anatomy of the maxillary artery for extracranial-intracranial bypass in the pterygopalatine segment of the maxillary artery. Clin Anat 2017; 31:724-733. [PMID: 28556192 DOI: 10.1002/ca.22926] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 05/22/2017] [Indexed: 11/06/2022]
Abstract
The extracranial-intracranial (EC-IC) bypass using the maxillary artery (MA) has been successfully completed using a radial artery (RA) graft but the complicated anatomy and narrow exposure make it difficult. The purpose of this article is to define the microsurgical exposure of the MA through the middle fossa and describe the branches, diameter, and length of the MA available for the EC-IC bypass in the sphenopalatine fossa and anterior part of the infratemporal fossa. 5 cadaveric specimens were dissected bilaterally (10 MA dissections) to define the microsurgical anatomy of the MA through an intracranial approach. The exposable branches of the MA at the level of the infratemporal and sphenopalatine fossae were the anterior deep temporal, posterior superior alveolar, and infraorbital arteries. The origin of each branch could be exposed. The available section of the MA for use as a donor vessel is between the origin of the anterior deep temporal artery and the infraorbital artery. The mean exposable length of the MA was 19.4 mm. The mean outer diameter of the donor MA was 3.2 mm. Tension-free EC-IC bypass was possible using a RA graft between the MA and the middle cerebral artery, the MA and the supraclinoid internal carotid artery (ICA), or the MA and the petrous ICA. Exposure of the MA at the infratemporal and sphenopalatine fossae is complicated but provides length and diameter suitable as a donor artery for the EC-IC bypass. Clin. Anat. 31:724-733, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Osamu Akiyama
- Department of Neurological Surgery, University of Florida Gainesville, Florida.,Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Abuzer Güngör
- Department of Neurological Surgery, University of Florida Gainesville, Florida.,Department of Neurosurgery, Bakirkoy Research and Training Hospital for Neurology, Neurosurgery, and Psychiatry, Istanbul, Turkey
| | | | - Akihide Kondo
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
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22
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Alvernia JE, Hidalgo J, Sindou MP, Washington C, Luzardo G, Perkins E, Nader R, Mertens P. The maxillary artery and its variants: an anatomical study with neurosurgical applications. Acta Neurochir (Wien) 2017; 159:655-664. [PMID: 28191601 DOI: 10.1007/s00701-017-3092-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/17/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The maxillary artery (MA) has gained attention in neurosurgery particularly in cerebral revascularization techniques, intracranial endonasal approaches and endovascular procedures. OBJECTIVES To describe and illustrate the anatomy of the MA and its neurosurgical importance in a detailed manner. METHODS Six cadaveric heads (12 MAs) were injected with latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques. The dimensions, course and branching patterns of the MA were recollected. In addition, 20 three-dimensional reconstruction CT head and neck angiograms (3D CTAs) of actual patients were correlated with the cadaveric findings. RESULTS The MA can be divided in three segments: mandibular, pterygoid and pterygopalatine. Medial and lateral trunk variants regarding its course around the lateral pterygoid muscle can be found. The different branching patterns of the MA have a direct correlation with the course of its main trunk at the base of the skull. Branching and trunk variants on one side do not predict the findings on the contralateral side. CONCLUSION In this study the highly variable course, branching patterns and relations of the MA are illustrated and described in human cadaveric heads and 3D CTAs. MA 3D CTA with bone reconstruction can be useful preoperatively for the identification of the medial or lateral course variants of this artery, particularly its pterygoid segment, which should be taken into account when considering the MA as a donor vessel for an EC-IC bypass.
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Affiliation(s)
- Jorge E Alvernia
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Joaquin Hidalgo
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marc P Sindou
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
| | - Chad Washington
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gustavo Luzardo
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eddie Perkins
- Neurosurgery and Skull Base Simulation Laboratory, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
- Department of Neurological Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Remi Nader
- Texas Center for Neuroscience, Houston, TX, USA
| | - Patrick Mertens
- CHU de Lyon-Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France
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23
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Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Exposure of the Maxillary Artery. World Neurosurg 2017; 100:540-550. [PMID: 28089839 DOI: 10.1016/j.wneu.2016.12.130] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/28/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To define the maxillary artery (MaxA) anatomy and present a novel technique for exposing and preparing this vessel as a bypass donor. METHODS Cadaveric and radiologic studies were used to define the MaxA anatomy and show a novel method for harvesting and preparing it for extracranial to intracranial bypass. RESULTS The MaxA runs parallel to the frontal branch of the superficial temporal artery and is located on average 24.8 ± 3.8 mm inferior to the midpoint of the zygomatic arch. The pterygoid segment of the MaxA is most appropriate for bypass with a maximal diameter of 2.5 ± 0.4 mm. The pterygoid segment can be divided into a main trunk and terminal part based on anatomic features and use in the bypass procedure. The main trunk of the pterygoid segment can be reached extracranially, either by following the deep temporal arteries downward toward their origin from the MaxA or by following the sphenoid groove downward to the terminal part of the pterygoid segment, which can be followed proximally to expose the entire MaxA. In comparison, the prebifurcation diameter of the superficial temporal artery is 1.9 ± 0.5 mm. The average lengths of the mandibular and pterygoid MaxA segments are 6.3 ± 2.4 and 6.7 ± 3.3 mm, respectively. CONCLUSIONS The MaxA can be exposed without zygomatic osteotomies or resection of the middle fossa floor. Anatomic landmarks for exposing the MaxA include the anterior and posterior deep temporal arteries and the pterygomaxillary fissure.
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24
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Flow reversal bypass surgery: a treatment option for giant serpentine and dolichoectatic aneurysms—internal maxillary artery bypass with an interposed radial artery graft followed by parent artery occlusion. Neurosurg Rev 2016; 40:319-328. [DOI: 10.1007/s10143-016-0778-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/09/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
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25
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Liu J, Sun X, Liu Q, Wang D, Wang H, Ma N. Eustachian Tube as a Landmark to the Internal Carotid Artery in Endoscopic Skull Base Surgery. Otolaryngol Head Neck Surg 2015; 154:377-82. [PMID: 26598497 DOI: 10.1177/0194599815616799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/21/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to probe the relationship between the eustachian tube and the internal carotid artery in skull base surgery by an intranasal endoscopic approach. STUDY DESIGN Cadaver study and illustrative cases. SETTING Minimally invasive surgery laboratory and operating room. SUBJECTS AND METHODS A series of 5 cadaveric heads were dissected to elaborate on the relevant surgical anatomy about the eustachian tube and the internal carotid artery. Three cases were presented to illustrate the application of our laboratory findings. RESULTS The bony-cartilaginous junction of the eustachian tube was just anterior to the first genu of the internal carotid artery by an intranasal endoscopic approach. The 3 patients in our study tolerated the procedure well and experienced no serious complications after surgery. CONCLUSIONS The anatomic data and clinical cases in this study confirmed that the eustachian tube is a consistent and reliable landmark to the internal carotid artery to avoid its injury in skull base surgery through the endoscopic endonasal route.
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Affiliation(s)
- Juan Liu
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China
| | - Xicai Sun
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China
| | - Quan Liu
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China
| | - Dehui Wang
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China
| | - Huan Wang
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China
| | - Na Ma
- Department of Otolaryngology, Eye, Ear, Nose, and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, People's Republic of China
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Nossek E, Costantino PD, Chalif DJ, Ortiz RA, Dehdashti AR, Langer DJ. Forearm Cephalic Vein Graft for Short, “Middle”-Flow, Internal Maxillary Artery to Middle Cerebral Artery Bypass. Oper Neurosurg (Hagerstown) 2015; 12:99-105. [DOI: 10.1227/neu.0000000000001027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Erez Nossek
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | - Peter D Costantino
- The New York Head & Neck Institute, Hofstra North Shore—Long Island Jewish School of Medicine, New York, New York
| | - David J Chalif
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | - Rafael A Ortiz
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | - Amir R Dehdashti
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
| | - David J Langer
- Department of Neurosurgery, Hofstra North Shore-LIJ School of Medicine, Manhasset, New York
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Ma L, Li J, Zhang X, Ren H, Xu Z, Huang Y, Jiang R. Training of deep microsurgical skill: Establishment of a high-volume intracranial carotid bypass model. Neurochirurgie 2015; 61:312-7. [PMID: 26271400 DOI: 10.1016/j.neuchi.2015.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 04/18/2015] [Accepted: 05/23/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To establish a model for a high-volume intracranial carotid bypass operation. METHODS High-volume internal carotid-middle cerebral artery bypass was performed on 9 cadaver heads with arteries of porcine forearms as grafts by 6 residents with no previous experience in vascular anastomosis on cadavers. The intima was dissected immediately after the anastomoses were completed to observe the patency of anastomosis. RESULTS After different duration periods of training using this model, 36 vascular anastomoses on 18 sides were successfully performed by the 6 residents with a self-made difficulty regulation device. As the difficulty level increased, the time needed for anastomosis lengthened and patency rate showed a decreasing trend. As the amount of training increased, the residents were able to decrease the amount of time to complete the operation with increasing patency rates. CONCLUSIONS The model of high-volume internal carotid-middle cerebral artery bypass with arteries of porcine forearms has the advantages of material similarity, easy access of grafts, better simulation of intraoperative conditions, and adjustable difficulties. Our results suggest that this new procedure has a better simulation-training platform which is closer to the real surgical procedure for surgeons willing to master the technique of a high-volume bypass operation.
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Affiliation(s)
- L Ma
- Department of neurosurgery, Tianjin Medical University General Hospital, 300052 Tianjin, China; Department of neurosurgery, Tianjin Huanhu Hospital, 300060 Tianjin, China
| | - J Li
- Department of neurosurgery, Tianjin Huanhu Hospital, 300060 Tianjin, China
| | - X Zhang
- Department of neurosurgery, Central Hospital of ZiBo, ZiBo, 255036 Shandong Province, China
| | - H Ren
- Department of neurosurgery, Tianjin Huanhu Hospital, 300060 Tianjin, China
| | - Z Xu
- Department of neurosurgery, Tianjin Huanhu Hospital, 300060 Tianjin, China
| | - Y Huang
- Department of neurosurgery, Tianjin Huanhu Hospital, 300060 Tianjin, China.
| | - R Jiang
- Department of neurosurgery, Tianjin Medical University General Hospital, 300052 Tianjin, China.
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Nossek E, Costantino PD, Eisenberg M, Dehdashti AR, Setton A, Chalif DJ, Ortiz RA, Langer DJ. Internal maxillary artery-middle cerebral artery bypass: infratemporal approach for subcranial-intracranial (SC-IC) bypass. Neurosurgery 2015; 75:87-95. [PMID: 24618804 PMCID: PMC4053591 DOI: 10.1227/neu.0000000000000340] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: Internal maxillary artery (IMax)–middle cerebral artery (MCA) bypass has been recently described as an alternative to cervical extracranial-intracranial bypass. This technique uses a “keyhole” craniectomy in the temporal fossa that requires a technically challenging end-to-side anastomosis. OBJECTIVE: To describe a lateral subtemporal craniectomy of the middle cranial fossa floor to facilitate wide exposure of the IMax to facilitate bypass. METHODS: Orbitozygomatic osteotomy is used followed by frontotemporal craniotomy and subsequently laterotemporal fossa craniectomy, reaching its medial border at a virtual line connecting the foramen rotundum and foramen ovale. The IMax was identified by using established anatomic landmarks, neuronavigation, and micro Doppler probe (Mizuho Inc. Tokyo, Japan). Additionally, we studied the approach in a cadaveric specimen in preparation for microsurgical bypass. RESULTS: There were 4 cases in which the technique was used. One bypass was performed for flow augmentation in a hypoperfused hemisphere. The other 3 were performed as part of treatment paradigms for giant middle cerebral artery aneurysms. Vein grafts were used in all patients. The proximal anastomosis was performed in an end-to-side fashion in 1 patient and end-to-end in 3 patients. Intraoperative graft flow measured with the Transonic flow probe ranged from 20 to 60 mL/min. Postoperative angiography demonstrated good filling of the graft with robust distal flow in all cases. All patients tolerated the procedure well. CONCLUSION: IMax to middle cerebral artery subcranial-intracranial bypass is safe and efficacious. The laterotemporal fossa craniectomy technique resulted in reliable identification and wide exposure of the IMax, facilitating the proximal anastomosis. ABBREVIATIONS: EC-IC, extracranial-intracranial IMax, internal maxillary artery MCA, middle cerebral artery SC-IC, subcranial-intracranial STA, superficial temporal artery
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Affiliation(s)
- Erez Nossek
- *Department of Neurosurgery, North Shore - Long Island Jewish/Hofstra School of Medicine North Shore University Hospital, Manhasset, NY; ‡Department of Neurosurgery, North Shore - Long Island Jewish/Hofstra School of Medicine North Shore University Hospital Lenox Hill Hospital; New York, NY; §The New York Head & Neck Institute, North Shore- Long Island Jewish/Hofstra School of Medicine Lenox Hill Hospital, New York, NY
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Middle infratemporal fossa less invasive approach for radical resection of parapharyngeal tumors: surgical microanatomy and clinical application. Neurosurg Rev 2015; 39:87-96; discussion 96-7. [PMID: 26160680 DOI: 10.1007/s10143-015-0655-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/22/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
Surgery of the infratemporal fossa (ITF) and parapharyngeal area presents a formidable challenge to the surgeon due to its anatomical complexity and limited access. Conventional surgical approaches to these regions were often too invasive and necessitate sacrifice of normal function and anatomy. To describe a less invasive transcranial extradural approach to ITF parapharyngeal lesions and to determine its advantages, 17 patients with ITF parapharyngeal neoplasms who underwent tumor resection via this approach were enrolled in the study. All lesions located in the ITF precarotid parapharyngeal space were resected through a small operative corridor between the trigeminal nerve third branch (V3) and the temporomandibular joint (TMJ). Surgical outcomes and postoperative complications were evaluated. Pathological diagnosis included schwannoma in eight cases, paraganglioma in two cases, gangliocytoma in two cases, carcinosarcoma in one case, giant cell tumor in one case, pleomorphic adenoma in one case, chondroblastoma in one case, and juvenile angiofibroma in one case. Gross total resection was achieved in 12 cases, near-total and subtotal resection were in 3 and 2 cases, respectively. The most common postoperative complication was dysphagia. Surgical exposure can be customized from minimal (drilling of retrotrigeminal area) to maximal (full skeletonization of V3, removal of all structures lying lateral to the petrous segment of internal carotid artery) according to tumor size and location. Since the space between the V3 and TMJ is the main corridor of this approach, the key maneuver is the anterior translocation of V3 to obtain an acceptable surgical field.
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Youssef A, Carrau RL, Tantawy A, Ibraheim A, Solares AC, Otto BA, Prevedello DM, Filho LD. Endoscopic versus Open Approach to the Infratemporal Fossa: A Cadaver Study. J Neurol Surg B Skull Base 2015; 76:358-64. [PMID: 26401477 DOI: 10.1055/s-0035-1549003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/26/2015] [Indexed: 10/23/2022] Open
Abstract
Introduction Various lateral and anterior approaches to access the infratemporal fossa (ITF) have been described. We provide our observations regarding the endoscopic transpterygoid and preauricular subtemporal approaches, listing their respective advantages and limitations through cadaveric dissection. Methods A cadaver study was performed on five adult specimens. An endoscopic transpterygoid approach to the ITF was completed bilaterally in three specimens, and an open preauricular ITF approach was performed bilaterally in two specimens. Results After completing the cadaveric dissections, we studied differences between the endoscopic transpterygoid approach and open preauricular subtemporal approaches in regard to exposure and ease of dissection of different structures in the ITF. Conclusions In comparison with a lateral approach, the endonasal endoscopic transpterygoid approach provides better visualization and more direct exposure of median structures such as the nasopharynx, eustachian tube, sella, and clivus. We concluded that the endoscopic transpterygoid approach can be utilized to resect benign lesions and some select group of malignancies involving the infratemporal and middle cranial fossae. Open approaches continue to play an important role, especially in the resection of extensive malignant tumors extending to these regions.
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Affiliation(s)
- Ahmed Youssef
- Department of Otolaryngology-Head and Neck Surgery, Alexandria University, El Azareeta, Alexandria, Egypt
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
| | - Ahmed Tantawy
- Department of Otolaryngology-Head and Neck Surgery, Alexandria University, El Azareeta, Alexandria, Egypt
| | - Ahmed Ibraheim
- Department of Otolaryngology, Alexandria Medical School, Ramel Station, Alexandria, Egypt
| | - Arturo C Solares
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents Medical Center, Augusta, Georgia, United States
| | - Bradley A Otto
- Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
| | - Daniel M Prevedello
- Department of Neurosurgery, The University of Ohio, Columbus, Ohio, United States
| | - Leo Ditzel Filho
- Department of Neurosurgery, The University of Ohio, Columbus, Ohio, United States
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Abstract
OBJECTIVE The objective of this work was to explore the feasibility of bypass between the maxillary artery (MA) and proximity of middle cerebral artery (MCA). METHODS Ten fixed and perfused adult cadaver heads were dissected bilaterally, 20 sides in total. The superficial temporal artery and its 2 branches were dissected, and outer diameters were measured. The MA and its branch were exposed as well as deep temporal artery; outer diameter of MA was measured. The lengths between the external carotid artery, internal carotid artery, maxillary artery, and proximal middle cerebral artery were measured. Ten healthy adults as targets (20 sides), inner diameter and blood flow dynamic parameters of the common carotid artery, external carotid artery, internal carotid artery, maxillary artery, superficial temporal artery, and its 2 branches were done with ultrasound examination. RESULTS The mean outer diameter of MA (2.60 ± 0.20 mm) was larger than that of the temporal artery trunk (1.70 ± 0.30 mm). The mean lengths of graft vessels between the internal carotid artery, external carotid artery, and the bifurcation section of MCA (171.00 ± 2.70 and 162.40 ± 2.60 mm) were longer than the mean lengths of graft vessels between MA and MCA bifurcation section (61.70 ± 1.50 mm). In adults, the mean blood flow of the second part of MA (62.70 ± 13.30 mL/min) was more than that of the 2 branches of the superficial temporal artery (15.90 ± 3.70 mL/min and 17.70 ± 4.10 ml/min). CONCLUSION Bypass between the maxillary artery and proximity of middle cerebral artery is feasible. It is a kind of effective high flow bypass with which the graft vessel is shorter and straighter than the bypass between internal carotid artery or external carotid artery and proximity of middle cerebral artery.
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Guidera AK, Dawes PJD, Fong A, Stringer MD. Head and neck fascia and compartments: no space for spaces. Head Neck 2014; 36:1058-68. [PMID: 23913739 DOI: 10.1002/hed.23442] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 05/18/2013] [Accepted: 07/24/2013] [Indexed: 01/28/2023] Open
Abstract
An accurate understanding of the arrangement of cervical fascia and its associated compartments is essential for differential diagnosis, predicting the spread of disease, and surgical management. The purpose of this detailed review is to summarize the anatomic, clinical, and radiological literature to determine what is known about the arrangement of cervical fascia and to highlight controversies and consensus. The current terminology used to describe cervical fascia and compartments is replete with confusing synonyms and inconsistencies, creating important interdisciplinary differences in understanding. The term "spaces" is inappropriate. A modified nomenclature underpinned by evidence-based anatomic and radiologic findings is proposed. This should not only enhance our understanding of cervical anatomy but also facilitate clearer interdisciplinary communication.
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Affiliation(s)
- Alice K Guidera
- Department of Surgical Sciences, Dunedin School of Medicine, Dunedin, New Zealand
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Joo W, Yoshioka F, Funaki T, Mizokami K, Rhoton AL. Microsurgical anatomy of the trigeminal nerve. Clin Anat 2013; 27:61-88. [PMID: 24323792 DOI: 10.1002/ca.22330] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 09/05/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Wonil Joo
- Department of Neurosurgery; Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine; Seoul South Korea
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Fumitaka Yoshioka
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Takeshi Funaki
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Koji Mizokami
- Department of Neurosurgery; University of Florida; Gainesville Florida
| | - Albert L. Rhoton
- Department of Neurosurgery; University of Florida; Gainesville Florida
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Eller JL, Sasaki-Adams D, Sweeney JM, Abdulrauf SI. Localization of the Internal Maxillary Artery for Extracranial-to-Intracranial Bypass through the Middle Cranial Fossa: A Cadaveric Study. J Neurol Surg B Skull Base 2013; 73:48-53. [PMID: 23372995 DOI: 10.1055/s-0032-1304556] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 08/16/2011] [Indexed: 10/28/2022] Open
Abstract
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 latex-injected 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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Affiliation(s)
- Jorge L Eller
- Department of Neurosurgery, Center for Cerebrovascular and Skull Base Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
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Joo W, Funaki T, Yoshioka F, Rhoton AL. Microsurgical anatomy of the infratemporal fossa. Clin Anat 2013; 26:455-69. [DOI: 10.1002/ca.22202] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 10/15/2012] [Accepted: 10/18/2012] [Indexed: 11/07/2022]
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Lee DL, McCoul ED, Anand VK, Schwartz TH. Endoscopic endonasal access to the jugular foramen: defining the surgical approach. J Neurol Surg B Skull Base 2012; 73:342-51. [PMID: 24083127 PMCID: PMC3578641 DOI: 10.1055/s-0032-1322796] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 02/12/2012] [Indexed: 10/28/2022] Open
Abstract
Introduction The endoscopic endonasal approach to the parapharyngeal space (PPS) and jugular foramen is not well defined. We sought to systematically define the important landmarks and limitations of this new surgical technique using an endoscopic transmaxillary transpterygoid corridor. Methods Endoscopic dissection was performed in both sides of two latex-injected cadaver heads. Left-sided dissections were facilitated by the addition of a sublabial maxillary antrostomy. The pterygopalatine fossa, infratemporal fossa, and PPS were sequentially dissected and the endoscopic perspective was examined. Measurements were obtained from the surgical orifices to the upper cervical internal carotid artery (ICA) and internal jugular vein (IJV). Results Successful access to the PPS and jugular foramen was achieved in each dissection. The lateral pterygoid plate, mandibular branch of the trigeminal nerve, middle meningeal artery, levator veli palatini muscle, Eustachian tube, and stylopharyngeal fascia were identified as landmarks for the upper cervical ICA and the IJV. The mean distance from the nasal sill was markedly greater than from an ipsilateral sublabial antrostomy. Conclusion The endoscopic endonasal approach can provide adequate access to the PPS, carotid sheath, and jugular foramen. Multiple landmarks are useful to guide the dissection within these deep spaces and may facilitate the clinical application of this approach.
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Affiliation(s)
- Dennis L.Y. Lee
- Department of Ear, Nose and Throat, United Christian Hospital, Affiliated Unit of the Chinese University of Hong Kong, Kwun Tong, New Kowloon, Hong Kong
| | - Edward D. McCoul
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, United States
| | - Vijay K. Anand
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, United States
| | - Theodore H. Schwartz
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, United States
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, United States
- Department of Neurology and Neuroscience, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, United States
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Extradural Subtemporal Transzygomatic Approach to the Clival and Paraclival Region With Endoscopic Assist. J Craniofac Surg 2012; 23:1468-75. [DOI: 10.1097/scs.0b013e31825a6497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ohue S, Fukushima T, Kumon Y, Ohnishi T, Friedman AH. Preauricular transzygomatic anterior infratemporal fossa approach for tumors in or around infratemporal fossa lesions. Neurosurg Rev 2012; 35:583-92; discussion 592. [DOI: 10.1007/s10143-012-0389-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 11/25/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
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Kuriakose MA, Sorin A, Sharan R, Fishman AJ, Babu R, Delacure MD. Quantitative evaluation of transtemporal and facial translocation approaches to infratemporal fossa. Skull Base 2011; 18:17-27. [PMID: 18592023 DOI: 10.1055/s-2007-992765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare the extent of exposure and surgical maneuverability provided by facial translocation and transtemporal approaches for access to the infratemporal fossa and anterolateral skull base. MATERIALS AND METHODS Surgical procedures were performed on five fresh frozen adult cadavers (ten sides) with no known pathology. Facial transfacial approaches with and without a mandibulotomy and transtemporal approaches were evaluated. OBJECTIVE measures were (1) the distance from the surgical plane to designated anatomic landmarks and (2) the surgical angle of exposure. RESULTS Distances from the surgical plane to the anatomic reference points were comparable for most of the access procedures (3 to 6 cm). The extended midfacial translocation and bilateral facial translocation approaches did, however, provide a shorter operative distance (1 to 3 cm) for access to the infratemporal fossa and contralateral structures, respectively. The transtemporal approaches facilitate a better angle of exposure (74 to 84 degrees) to the petrotemporal region, while the transfacial approaches were superior for access to the infratemporal structures. CONCLUSIONS Based on the results, we propose a clinical algorithm for selecting a surgical approach based on the position and extent of an infratemporal or petrotemporal lesion.
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Affiliation(s)
- Moni A Kuriakose
- Head and Neck Institute, Amrita Institute of Medical Sciences, Kerala, India
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40
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Terasaka S, Sawamura Y, Goto S, Fukushima T. A lateral transzygomatic-transtemporal approach to the infratemporal fossa: technical note for mobilization of the second and third branches of the trigeminal nerve. Skull Base Surg 2011; 9:277-87. [PMID: 17171117 PMCID: PMC1656782 DOI: 10.1055/s-2008-1058138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This report describes an alternative approach to the infratemporal fossa lesions through a lateral zygomato-temporal craniotemy, which modifies the extradural temporopolar technique for cavernous sinus surgery. First, an L-shaped osteotomy of the zygoma from the frontozygomatic suture attaching the zygomatre arch and low positioned temporal cramotomy are made. Through this zygomato-temporal craniotomy and orbitotemporal drilling, leaving the lateral orbital rim and orbital roof intact, skeletonization of the foramens rotundum and ovale are carried out. The key element of this infratemporal exposure is the dissection and mobilization of the trigeminal nerve, trigeminal second branch rostrally, and the third branch caudally, which facilitates a wide exposure of the infratemporal fossa with preserving trigeminal function. The corridor between the mobilized trigeminal branches provides direct access to the lateral and medial pterygoid plate, internal maxillary artery, sphenoid and maxillary sinuses, maxilla and, finally, the parapharyngeal area. Our experiences have demonstrated that this lateral transzygomatic-transtemporal exposure is satisfactory for use with infratemporal fossa tumors. This approach has an advantage for cranial-base exposure with decreased risks of cosmetic deformity and of trigeminal nerve dysfunction.
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Isolan GR, Rowe R, Al-Mefty O. Microanatomy and surgical approaches to the infratemporal fossa: an anaglyphic three-dimensional stereoscopic printing study. Skull Base 2011; 17:285-302. [PMID: 18330427 DOI: 10.1055/s-2007-985193] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The infratemporal fossa (ITF) is a continuation of the temporal fossa between the internal surface of the zygoma and the external surface of the temporal bone and greater wing of the sphenoid bone that is sitting deep to the ramus of the mandible. The principal structure to understanding its relationships is the lateral pterygoid muscle. Other important structures are the medial pterygoid muscle, the maxillary artery, the pterygoid venous plexus, the otic ganglion, the chorda tympani nerve and the mandibular nerve. In this study, we describe the microsurgical anatomy of the ITF, as viewed by step-by-step anatomical dissection and also through the perspective of three lateral approaches and one anterior surgical approach. METHODS Eight cadaver specimens were dissected. In one side of all specimens, an anatomical dissection was done in which a wide preauricular incision from the neck on the anterior border of the sternoclidomastoid muscle at the level of the cricoid cartilage to the superior temporal line was made. The flap was displaced anteriorly and the structures of the neck were dissected followed by a zygomatic osteotomy and dissection of the ITF structures. On the other side were the surgical approaches to the ITF. The combined infratemporal and posterior fossa approach was done in two specimens, the subtemporal preauricular infratemporal fossa approach in two, the zygomatic approach in two, and the lateral transantral maxillotomy in two. The anatomical dissections were documented on the three-dimensional (3D) anaglyphic method to produce stereoscopic prints. RESULTS The lateral pterygoid muscle is one of the principal structures to enable understanding of the relationships into the ITF. The tendon of the temporal muscle inserts in the coronoid process at the ITF. The maxillary artery is the terminal branch of the external carotid artery that originates at the neck of the mandible and runs into the parotid gland. In our dissections the maxillary artery was lateral to the buccal, lingual, and inferior alveolar nerves. We found the second part of the maxillary artery superficial to the lateral pterygoid muscle in all specimens The anterior and posterior branches of the deep temporal artery supply the temporal muscle. In two cases we found a middle deep temporal artery. The different approaches that we used provided different views of the same anatomical landmarks and this provides not only safer surgery but also the best choice to approach the ITF according with the pathology extension. CONCLUSIONS The ITF is a complex region on the skull base that is affected by benign and malignant tumors. The study through different routes is helpful to disclose the relationship among the anatomical structures. Although the authors have shown four approaches, there are a variety of approaches and even a combination of these can be used. This type of anatomical knowledge is essential to choosing the best approach to treat lesions in this area.
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Affiliation(s)
- Gustavo Rassier Isolan
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Mousa Sadr Hosseini S, Razfar A, Carrau RL, Prevedello DM, Fernandez-Miranda J, Zanation A, Kassam AB. Endonasal transpterygoid approach to the infratemporal fossa: Correlation of endoscopic and multiplanar CT anatomy. Head Neck 2011; 34:313-20. [DOI: 10.1002/hed.21725] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2010] [Indexed: 11/06/2022] Open
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Abdulrauf SI, Sweeney JM, Mohan YS, Palejwala SK. Short Segment Internal Maxillary Artery to Middle Cerebral Artery Bypass: A Novel Technique for Extracranial-to-Intracranial Bypass. Neurosurgery 2011; 68:804-8; discussion 808-9. [DOI: 10.1227/neu.0b013e3182093355] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Traditional high-flow extracranial-to-intracranial (EC-IC) bypass procedures require a cervical incision and a long (20–25 cm) radial artery or saphenous vein graft. This technical note describes a less invasive, EC-IC bypass technique using a short-segment (8–10 cm) of the radial artery to anastomose the internal maxillary artery (IMAX) to the middle cerebral artery.
CLINICAL PRESENTATION:
Anatomic dissections were performed on 6 cadaveric specimens to assess the location of the IMAX artery using an extradural middle fossa approach. Subsequently, the procedure was implemented in a patient with a giant fusiform internal carotid artery aneurysm.
TECHNIQUE:
A straight line was drawn anteriorly from the V2/V3 apex along the inferior edge of V2. The IMAX was found 8.6 mm on average anteriorly from the lateral edge of the foramen rotundum. We drilled to a depth of 4.2 mm on average to find the medial extent of the artery and then lateral and deep drilling exposed an average of 7.8 mm of graft. The IMAX was consistently found running just anterior and parallel to a line between the foramens rotundum and ovale. In the clinical case presented, both intraoperative indocyanine green and postoperative conventional angiography revealed a patent graft. The patient did well clinically without any new deficits.
CONCLUSION:
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.
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Affiliation(s)
- Saleem I. Abdulrauf
- Saint Louis University Center for Cerebrovascular and Skullbase Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Justin M. Sweeney
- Saint Louis University Center for Cerebrovascular and Skullbase Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Yedathore S. Mohan
- Saint Louis University Center for Cerebrovascular and Skullbase Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Sheri K. Palejwala
- Saint Louis University Center for Cerebrovascular and Skullbase Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
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Falcon RT, Rivera-Serrano CM, Miranda JF, Prevedello DM, Snyderman CH, Kassam AB, Carrau RL. Endoscopic endonasal dissection of the infratemporal fossa: Anatomic relationships and importance of eustachian tube in the endoscopic skull base surgery. Laryngoscope 2010; 121:31-41. [DOI: 10.1002/lary.21341] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hwang SW, Rahal JP, Wein RO, Heilman CB. Temporal craniotomy for surgical access to the infratemporal fossa. Skull Base 2010; 20:93-9. [PMID: 20808533 DOI: 10.1055/s-0029-1246225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We propose a surgical approach for select patients that minimizes morbidity while allowing gross total resection of lesions in the anterior portion of the infratemporal fossa. The approach we describe is an extradural approach through a subtemporal craniectomy or craniotomy with the possible addition of a zygomatic osteotomy. Lesions that have a well-defined capsule and a texture that permits manipulation are ideal for this less invasive approach. We retrospectively reviewed six cases from the primary author (C.B.H.) using a temporal craniectomy or craniotomy alone to resect lesions in the infratemporal fossa. All six cases had good clinical outcomes with no unexpected neurological deficits while achieving gross total resections. The only complication included one cerebrospinal fluid leak that was sealed endoscopically. For select lesions, a less morbid surgical approach via an extradural window through a subtemporal craniectomy or small craniotomy may be preferable to transfacial approaches. Adjuvant use of endoscopic techniques may facilitate surgical exposure and resection of large lesions.
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Affiliation(s)
- Steven W Hwang
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts
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[Extended subtemporal approach to the subtemporal fossa and related structures - analysis of the surgical technique based on cadaver simulation]. Neurol Neurochir Pol 2010; 44:159-71. [PMID: 20496286 DOI: 10.1016/s0028-3843(14)60007-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The aim of the study was to present consecutive stages of the extended subtemporal approach (ESA). Seven simulations of ESA were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schemes. The starting point for ESA is osteotomy of the zygomatic arch and craniectomy including the greater wing of the sphenoid bone. Dislocation or removal of subtemporal fossa contents allows one to penetrate its inside and related structures. Additional widening of inspection allows osteotomy of the condyloid process of the mandible. ESA is a reproducible technique which provides surgical penetration of the subtemporal fossa and related structures. This approach is particularly useful in the surgical treatment of tumours expanding in the orbit, maxillary sinus, pterygopalatine fossa, nasopharynx, sphenoid sinus, cavernous sinus, parapharyngeal space, retromandibular fossa and surroundings of the petrosal part of the internal carotid artery.
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Dennison J, Batra A, Herbison P. The maxillary artery and the lateral pterygoid muscle: the New Zealand story. ACTA ACUST UNITED AC 2010; 108:e26-9. [PMID: 19836710 DOI: 10.1016/j.tripleo.2009.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 07/03/2009] [Accepted: 07/17/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The most recent study of the relationship between the maxillary artery and the lateral pterygoid muscle was published in this journal in 2008.(1) Given the controversy surrounding this relationship, our purpose was to present data gathered from New Zealand caucasoid cadavers over several years. STUDY DESIGN Both sides of 92 caucasoid adult cadaveric heads (45 male, 47 female) were dissected by 3 successive years of third-year medical students and second-year dental students. The infratemporal approach was used. Once the dissections reached the plane of the maxillary artery and lateral pterygoid muscle, their relationship was recorded, together with exemplary images. Sexual and symmetrical differences were noted. RESULTS In the 53 cases where bilateral dissection had been successful, the second part of the maxillary artery was found superficial to the lower head of the lateral pterygoid muscle in 30 cases (57%)-in 70% of the males and 39% of the females. One male and 1 female presented bilateral asymmetry. CONCLUSIONS The finding of 2 cases of bilateral asymmetry among the 53 bilaterally dissected cadavers led to the consideration of each "hemi-head" as a single entity. This increased the sample size. Statistical analysis of the data, systematically broken down by sex and by side, showed that the second part of the maxillary artery is more likely to lie deep to the lower head of the lateral pterygoid muscle in females than in males, and that "side" is irrelevant.
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Affiliation(s)
- John Dennison
- Department of Anatomy and Structural Biology, University of Otago Medical School, Dunedin, New Zealand.
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Froelich SC, Abdel Aziz KM, Levine NB, Pensak ML, Theodosopoulos PV, Keller JT. Exposure of the Distal Cervical Segment of the Internal Carotid Artery Using the Trans-spinosum Corridor: Cadaveric Study of Surgical Anatomy. Oper Neurosurg (Hagerstown) 2008; 62:ONS354-61; discussion ONS361-2. [DOI: 10.1227/01.neu.0000326019.30058.7b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background:
Exposure of the most distal portion of the cervical segment of the internal carotid artery (ICA) is technically challenging. Previous descriptions of cranial base approaches to expose this segment noted facial nerve manipulation, resection of the glenoid fossa, and significant retraction or resection of the condyle. We propose a new approach using the frontotemporal orbitozygomatic approach to expose the distal portion of the cervical segment of the ICA via the trans-spinosum corridor.
Methods:
Six formalin-fixed injected heads were used for cadaveric dissection. Two blocs containing the carotid canal and surrounding region were used for histological examination.
Results:
The ICA lies immediately medial to the vaginal process. The carotid sheath attaches laterally to the vaginal process. With use of the trans-spinosum corridor, the surgeon's line of sight courses in front of the temporomandibular joint, through the foramen spinosum, spine of the sphenoid, and vaginal process. Removal of the vaginal process exposes the vertical portion of the petrous segment of the ICA. The loose connective tissue space between the adventitia and the carotid sheath is easily entered from above. Incision of the carotid sheath exposes the ICA without disruption of the temporomandibular joint.
Conclusion:
Control of the cervical segment of the ICA can be critical when dealing with cranial base tumors that invade or surround the petrous segment of the ICA. This novel technique through the trans-spinosum corridor can effectively expose the distal portion of the cervical segment of the ICA without causing manipulation of the facial nerve and while maintaining the integrity of the temporomandibular joint.
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Affiliation(s)
- Sebastien C. Froelich
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Khaled M. Abdel Aziz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Nicholas B. Levine
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Myles L. Pensak
- The Neuroscience Institute, Department of Otolaryngology, Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Philip V. Theodosopoulos
- The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine and Mayfield Clinic, Cincinnati, Ohio
| | - Jeffrey T. Keller
- The Neuroscience Institute, Department of Neurosurgery, University of Cincinnati College of Medicine and Mayfield Clinic, Cincinnati, Ohio
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Duckworth EAM, Silva FE, Chandler JP, Batjer HH, Zhao JC. Temporal bone dissection for neurosurgery residents: identifying the essential concepts and fundamental techniques for success. ACTA ACUST UNITED AC 2008; 69:93-8; discussion 98. [PMID: 18054623 DOI: 10.1016/j.surneu.2007.07.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 07/23/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many contemporary neurosurgery residents, cordoned by work hour restrictions and drawn to newer technologies such as endovascular therapy, lack the proper direction necessary to learn the essentials of temporal bone dissection. A thorough knowledge of temporal bone anatomy combined with guidance regarding proper surgical technique makes temporal bone dissection an efficacious and fundamental learning activity. There is currently no concise guide for neurosurgical training programs to use in teaching the essentials of this dissection. METHODS Over several years, the authors worked with neurosurgery residents to determine the key concepts necessary to gain a fundamental working knowledge of temporal bone dissection. RESULTS We have identified 5 essential surgical principles and developed a step-by-step dissection technique useful for neurosurgery residents. CONCLUSIONS Using this template, neurosurgery residents can make the most of their time in the skull base laboratory, becoming familiar with relevant temporal bone anatomy in situ and becoming facile with the surgical techniques necessary for its safe dissection.
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Affiliation(s)
- Edward A M Duckworth
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60622, USA
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Decuadro-Sáenz G, Castro G, Sorrenti N, Doassans I, Deleon S, Salle F, Saibene A, Santamaría A, Soria-Vargas V, Pérez-Brignani A. El nervio auriculotemporal. Bases neuroanatómicas del Síndrome de Frey. Neurocirugia (Astur) 2008. [DOI: 10.1016/s1130-1473(08)70241-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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