Skip to main content

Advertisement

SpringerLink
Log in

How I do it: internal maxillary artery to middle cerebral artery bypass to manage giant thrombosed internal carotid artery aneurysm

  • How I Do It - Vascular Neurosurgery - Aneurysm
  • Published:
Acta Neurochirurgica Aims and scope

Abstract

Background

Internal maxillary artery (IMA) bypass has become popularized due to its medium-to-high blood flow, short graft length, and well-matched arterial caliber between donor and recipient vessels.

Method

We described an open surgery of a NEW “workhorse,” the IMA bypass, to treat a giant, thrombosed cerebral aneurysm. The extracranial middle infratemporal fossa (EMITF) approach was used to unveil the pterygoid segment of the IMA for cerebral revascularization.

Conclusion

Although this technique is technically challenging, the variations in IMA can be effectively identified and sufficiently exposed in this technique to achieve favorable clinical outcomes with a high bypass patency rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

ECA:

External carotid artery

MCA:

Middle cerebral artery

ICA:

Internal carotid artery

ICG:

Indocyanine green

IMA:

Internal maxillary artery

LPM:

Lateral pterygoid muscle

MPM:

Medial pterygoid muscle

RA:

Radial artery

TM:

Temporalis muscle

I2 :

Pterygoid segment of internal maxillary artery

M2:

Sphenoidal segment of middle cerebral artery

References

  1. Nossek E, Costantino PD, Chalif DJ, Ortiz RA, Dehdashti AR, Langer DJ (2016) Forearm cephalic vein graft for short, “middle”-flow, internal maxillary artery to middle cerebral artery bypass. Oper Neurosurg 12(2):99–105

    Article  Google Scholar 

  2. Nossek E, Costantino PD, Eisenberg M, Dehdashti AR, Setton A, Chalif DJ, Ortiz RA, Langer DJ (2014)

  3. Nossek Erez, Costantino Peter D, Eisenberg Mark, Dehdashti Amir R, Setton Avi, Chalif David J, Ortiz Rafael A, Langer David J (2014) Internal Maxillary Artery-Middle Cerebral Artery Bypass: Infratemporal Approach for Subcranial-Intracranial (SC-IC) Bypass. Neurosurgery 75(1):87–95

    Article  PubMed  Google Scholar 

  4. Nossek E, Langer DJ (2018) Internal maxillary artery to middle cerebral artery cranial bypass: the new “work horse” for cerebral flow replacement. World Neurosurg 115:44–46

    Article  PubMed  Google Scholar 

  5. Patel NV, Ligas B, Gandhi S, Ellis J, Ortiz R, Costantino P, Qato K, Langer DJ (2020) Internal maxillary to middle cerebral artery bypass using an anterior tibial artery graft, performed using a 3-dimensional exoscope: 2-dimensional operative video. Oper Neurosurg 19(2):E187

    Article  Google Scholar 

  6. Wang L, Cai L, Lu S, Qian H, Lawton MT, Shi X (2018) The history and evolution of internal maxillary artery bypass. World Neurosurg 113:320–332

    Article  PubMed  Google Scholar 

  7. Wang L, Lu S, Cai L, Qian H, Tanikawa R, Shi X (2019) Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms. Neurosurg Focus 46:E10

    Article  PubMed  Google Scholar 

  8. Wang L, Lu S, Qian H, Shi X (2017) Internal maxillary artery bypass with radial artery graft treatment of giant intracranial aneurysms. World Neurosurg 105:568–584

    Article  PubMed  Google Scholar 

  9. Wang L, Lu S, Qian H, Shi X (2017) Internal maxillary bypass for complex pediatric aneurysms. World Neurosurg 103:395–403

    Article  PubMed  Google Scholar 

  10. Wang L, Shi X, Liu F, Qian H (2016) Bypass surgery to treat symptomatic fusiform dilation of the internal carotid artery following craniopharyngioma resection: report of 2 cases. Online publication of Neurosurg Focus 41:E17

  11. Wang L, Shi X, Qian H (2017) 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 40:319–328

    Article  PubMed  Google Scholar 

Download references

Funding

The Application and Evaluation of Active Health Cloud Platform in China, National Key R&D Program of China (2018YFC2000704).

Author information

Author notes

  1. Long Wang and Lujun Jing contributed equally  to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China

    Long Wang, Fangjun Liu & Xiang’en Shi

  2. Department of Stomatology, Beijing Electric Hospital, Capital Medical University, Beijing, China

    Lujun Jing

Authors
  1. Long Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lujun Jing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fangjun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiang’en Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: Wang. Acquisition of data: Wang, Liu, Shi. Drafting the article: Wang, Jing. Critically revising the article: Wang. Reviewed submitted version of manuscript: all authors. Study supervision: Wang, Shi.

Corresponding author

Correspondence to Long Wang.

Ethics declarations

Ethical approval

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Key points

1. The anatomy of the donor artery is the key to accomplishing IMA bypass.

2. A preoperative angiography study was performed to confirm the anatomical course and pattern of the IMA.

3. An RA graft of adequate length should be harvested to avoid tensive anastomosis status.

4. Zygomatic resection was mandatory for fully unveiling the neurovasculatures within the deeply located infratemporal fossa.

5. The 2nd segment of the IMA is the best candidate for well-matched anastomosis with RA grafts.

6. The Sylvian fissures should be adequately exposed as much as possible to reveal the distal structure and outflow of aneurysms.

7. Cut flow was measured before and after intracranial vascular anastomosis, and a higher ratio indicated a better patency rate.

8. Continuous irrigation with saline solution was used to make the surgical field clear and keep the tissues moist.

9. Adjunctive tools, such as neuro-monitoring, ICG imaging, and ultrasonic probes, were used to keep the bypass safe.

10. Blood pressure control, heparin therapy, and hydration had positive effects on the prevention of intracranial complications.

This article is part of the Topical Collection on Vascular Neurosurgery—Aneurysm

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 90327 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, L., Jing, L., Liu, F. et al. How I do it: internal maxillary artery to middle cerebral artery bypass to manage giant thrombosed internal carotid artery aneurysm. Acta Neurochir 165, 495–499 (2023). https://doi.org/10.1007/s00701-022-05463-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-022-05463-9

Keywords

Search

Navigation