• World Neurosurg · May 2024

    Localization of Maxillary artery for cerebral revascularization: L-shaped perpendicular two-step drilling technique stretching from the foramen ovale to rotundum.

    • Tufan Agah Kartum, Levent Aydin, Ender Vergili, Burak Tahmazoglu, Zeynep Dağlar, Barış Küçükyürük, and 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.
    • World Neurosurg. 2024 May 1; 185: e1101e1113e1101-e1113.

    BackgroundThe 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.MethodsFive silicone-injected adult cadaver heads (10 sides) were dissected. Safe and effective localization of the MA was evaluated.ResultsThe 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.ConclusionsConsidering 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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