Localization of the Internal Maxillary Artery for EC-IC Bypass through the Middle Cranial Fossa: A Cadaveric Study

Abstract

Background: The internal maxillary artery (IMAX) is a promising arterial pedicle to function as a donor vessel for extracranial-to-intracranial (EC-IC) bypass procedures. The access to the IMAX through the anterior portion of the middle fossa floor allows a much shorter interposition graft to be used to create a bypass to the ipsilateral MCA and prevents a second incision in the neck. This procedure has already been done successfully in the operating room; however, one of the challenges to solidify this technique has been the need to establish a reliable method to localize the IMAX through the middle fossa floor based on skull base landmarks. The purpose of this cadaveric study is to establish such relationships between the position of the IMAX as approached through the middle fossa floor and identifiable bony landmarks in the skull base.