• Hamdi Arbag, Aynur Emine Cicekcibasi, Ilknur Ismihan Uysal, Mehmet Erkan Ustun, and Mustafa Buyukmumcu.
• Department of Otorhinolaryngology, Head and Neck Surgery, Selcuk Universitesi, Meram Tip Fakultesi, Konya, Turkey. harbag@selcuk.edu.tr
• Acta Otolaryngol. 2005 Sep 1; 125 (9): 999-1003.

ConclusionUsing a transantral approach, we examined a new bypass of the maxillary artery (MA) to proximal middle cerebral artery (MCA). The caliber of the MA was suitable to provide sufficient blood flow. The length of the graft was shorter and it had a straighter course in the new technique than in previously described techniques.ObjectiveTo examine a new bypass of the MA to proximal MCA using a transantral approach as an alternative to other forms of anterior circulation bypass surgery.Material And MethodsThe method was applied to five adult cadavers bilaterally. The MA and its branches were easily found after removal of the posterior sinus wall using a transantral approach. Then, a hole was created in the sphenoid bone 5-6 mm lateral to the posteroinferior edge of the superior orbital fissure extradurally. After the carotid and sylvian cisternae had been opened, the M2 segment of the MCA was exposed. The MA was transected just before the origin of the descending palatine artery branch. After opening the dura over the hole, the MA was passed through the hole to reach the intracranial cavity. The proximal side of the superficial temporal artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the M2 segment of the MCA.ResultsThe mean caliber of the MA was 2.4+/-0.3 mm before the origin of the descending palatine artery branch. The mean caliber of the largest trunk of the M2 segment of the MCA was 2.3+/-0.3 mm. The average length of the graft was 24+/-3 mm.

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