Volumetric Models of Microsurgical and Endoscopic Anatomy of Internal Maxillary Artery Using Three-Dimensional Scanning Techniques

Background: Internal maxillary artery (IMAX) is considered one of the most complex and challenging structures in the neurosurgical anatomy. Because the vast majority of recent teaching tools are significantly limited to visualization and learn complex neuroanatomical structures and variations in neuroanatomy education, new and advanced technologies and techniques come into prominence in neuroanatomy area. The current study aims to generate three-dimensional (3D) volumetric models (VMs) that precisely portray the anatomic structure of IMAX and its relationship with bones, nerves, and muscles in its surrounding using 3D scanning techniques.

Method: Four embalmed cadaveric heads were dissected to expose the infratemporal and pterygopalatine fossa with microsurgical and endoscopic approaches. The images of branches of IMAX and its surrounding structures were captured using photogrammetry and structured light scanning techniques. Subsequently, Agisoft Metashape and Artec Studio softwares were used to align, smooth, and texturize the images into the complete 3D VMs.

Results: Five scans and an average of 155 photographs were used to construct for high-resolution 1 VM and high realistic 3 VMs, respectively. In the model 1, we simulated first and second segments of IMAX and branches of mandibular nerve (MN) in the infratemporal fossa. In the models 2, 3, and 4, we respectively simulated middle meningeal artery, foramen spinosum, ovale and rotundum in the lateral middle fossa, the pterygoid segment of the IMAX and mandibular nerve branches within the lateral infratemporal fossa, and the distal pterygopalatine segment of IMAX in the pterygopalatine fossa.

Conclusion: 3D anatomic knowledge between the branches of mandibular nerve and important muscle landmarks and branches of IMAX, and topographic anatomy knowledge of the infratemporal fossa is crucial to plan surgical approaches and to reduce postoperative complications. The complex structure of IMAX has made it one of the harder neuroanatomic structures to understand for student. These 3D VMs can help neurosurgeons plan their procedures and demonstrate them to patients, and students to easier understand the neuroanatomy of IMAX.

Publication History

Article published online:
12 February 2021