Abstract：
The 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.
Five silicone-injected adult cadaver heads (10 sides) were dissected. Safe and effective localization of the MA was evaluated.
The 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.
Considering 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.
Five silicone-injected adult cadaver heads (10 sides) were dissected. Safe and effective localization of the MA was evaluated.
The 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.
Considering 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.
摘要：
背景：使用上颌动脉（MA）作为供体已越来越成为脑血管重建术的替代方法。由于丰富的颞下解剖变异以及MA与神经肌肉结构的复杂关系，出现了定位困难。我们提出了一种替代的定位方法，该方法通过沿中间窝地板的孔之间路线进行定位。
方法：解剖了五个硅胶注射的成人尸体头部（10侧）。评估了MA的安全有效定位。
结果：MA显示出与翼外肌（LPM）和下颌神经分支有关的解剖学变异。拟议的L形垂直2步钻孔技术显示了一个较长的MA段，可以向颅内区域进行端到端吻合。钻孔的第一步涉及卵圆孔的内侧到外侧扩展，直至LPM上头的外侧边界。钻孔的第二步与初始路径成约90°的角度延伸，并向前到达圆孔。通过从后到前向内侧轻轻缩回LPM的上头来定位MA。
结论：考虑到所有解剖变异，通过椎间间隙的L形垂直两步钻孔技术是释放足够长度的MA的一种可实现的方法。这种技术的优点包括早期识别要钻探区域的精确地标，保留所有下颌神经分支，颞深动脉，并保持LPM的连续性。
方法：解剖了五个硅胶注射的成人尸体头部（10侧）。评估了MA的安全有效定位。
结果：MA显示出与翼外肌（LPM）和下颌神经分支有关的解剖学变异。拟议的L形垂直2步钻孔技术显示了一个较长的MA段，可以向颅内区域进行端到端吻合。钻孔的第一步涉及卵圆孔的内侧到外侧扩展，直至LPM上头的外侧边界。钻孔的第二步与初始路径成约90°的角度延伸，并向前到达圆孔。通过从后到前向内侧轻轻缩回LPM的上头来定位MA。
结论：考虑到所有解剖变异，通过椎间间隙的L形垂直两步钻孔技术是释放足够长度的MA的一种可实现的方法。这种技术的优点包括早期识别要钻探区域的精确地标，保留所有下颌神经分支，颞深动脉，并保持LPM的连续性。
