• Mingchu Li, Xu Wang, Shenjie Li, Guohuan Chen, Jian Ren, Ge Chen, Jiantao Liang, Yuhai Bao, and Liyong Sun.
• Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
• World Neurosurg. 2023 Jul 1; 175: e406e412e406-e412.

ObjectiveTo establish a new method for fast exposure of the internal maxillary artery (IMA) during extracranial-intracranial bypass surgery.MethodsTo 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.ResultsThe 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.ConclusionsThe 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.Copyright © 2023 Elsevier Inc. All rights reserved.

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