Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery: an anatomical and technical study.
OBJECTIVE
To examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery.


METHODS
The method was applied to five adult cadaver sides bilaterally. The MA was easily found 1-2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2-3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA.


RESULTS
The average diameter of the MA proximal to the infraorbital artery branch was 2.6+/-0.3 mm. The average diameter of the P2 was 2.2+/-0.2 mm. The average length of the graft was 47+/-5.2 mm.


CONCLUSIONS
As MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to "ECA to PCA" bypass.
Ulku
Cagatay Han
CH
Otolaryngology--Head and Neck Surgery, Selcuk University, Konya, Turkey. chanulku@yahoo.com
Ustun
Mehmet Erkan
ME
Buyukmumcu
Mustafa
M
Cicekcibasi
Aynur Emine
AE
Ziylan
Taner
T
D000714:Anastomosis, Surgical; D006801:Humans; D008438:Maxillary Artery / Q000033:anatomy & histology / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D020769:Posterior Cerebral Artery / Q000033:anatomy & histology / Q000601:surgery*; D017534:Radial Artery / Q000033:anatomy & histology / Q000637:transplantation*