• Xiong Li, Atakan Orscelik, Vera Vigo, Olivia Kola, Ivan H El-Sayed, Adib A Abla, and Roberto Rodriguez Rubio.
• Department of Neurosurgery, Bei Jing Chao Yang Hospital, Capital Medical University, Beijing, China; Skull Base and Cerebrovascular Laboratory, University of California, San Francisco, California, USA.
• World Neurosurg. 2020 Nov 1; 143: e232-e242.

BackgroundThe internal maxillary artery (IMAX) is currently considered one of the main donor vessels in extracranial-to-intracranial bypass surgeries. Four main techniques for harvesting the IMAX have been described: via the anterior medial infratemporal fossa (AMITF), the middle infratemporal fossa (MITF), the anterior lateral middle fossa (ALMF), and the lateral middle fossa (LMF). The advantages and limitations of these techniques have not yet been systematically evaluated and compared.MethodsTwenty-five cadaver specimens were used to evaluate the harvesting technique. The length and the caliber of the targeted IMAX segments, as well as the depth from the operating plane to the IMAX, surgical time, and surgical area of exposure, were analyzed.ResultsThe MITF technique provided the greatest operating area of exposure (mean, 3.88 ± 0.97 cm2). The LMF and MITF techniques provided the largest IMAX caliber (mean, 3.1 ± 0.4 mm and 3.0 ± 0.3 mm, respectively). The ALMF technique provided the shallowest operative depth as well as the least time of exposure (21.8 minutes). The MITF technique exposed the longest IMAX segment (mean, 18.8 ± 3.5 mm).ConclusionsAdvantages of the AMITF and MITF techniques include anatomic simplicity, absence of skull base drilling, and greater discretion in muscle dissection. These properties can simplify the anastomosis procedure compared with the ALMF and LMF techniques. Identification of the IMAX pattern is important before selecting the approach for this bypass operation.Copyright © 2020 Elsevier Inc. All rights reserved.

18 keywords...

hide…