Possibility of Middle Meningeal Artery-to-Petrous Internal Carotid Artery Bypass: An Anatomic Study

The possibility of creating a middle meningeal artery (MMA)-to-petrous internal carotid artery (ICA) bypass was investigated in six cadavers (bilaterally). Such a procedure could be used to treat patients with high cervical vascular lesions and those with tumors of the infratemporal fossa invading the high cervical ICA. After a frontotemporal craniotomy, the foramen spinosum and foramen ovale were exposed extradurally. Immediately posterior to the foramen ovale and medial to the foramen spinosum, the petrous portion of the ICA was exposed with a diamond-tipped drill. The MMA was lifted from its groove, and a sufficient length was transected to perform a bypass with the petrous ICA medially. The mean width of the MMA at the site of anastomosis was 2.3 ± 0.35 mm. The mean length of MMA from the foramen spinosum to the site of the anastomosis was 9.6 ± 1.7 mm. Based on these measurements, width and length of MMA appear to be sufficient for a bypass with petrous ICA.

KEYWORDS

Middle meningeal artery - internal carotid artery - bypass procedure - angiography

REFERENCES

• 1 Miyazaki S, Fukushima T, Fujimaki T. Resection of high-cervical paraganglioma with cervical-to-petrous internal carotid artery saphenous vein bypass. Report of two cases.  J Neurosurg. 1990;  73(1) 141-146
• 2 Fitzpatrick B C, Spetzler R F, Ballard J L, Zimmerman R S. Cervical-to-petrous internal carotid artery bypass procedure. Technical note.  J Neurosurg. 1993;  79 138-141
• 3 Diaz F G, Pearce J, Ausman J I. Complications of cerebral revascularization with autogenous vein grafts.  Neurosurgery. 1985;  17 271-276
• 4 Sen C, Sekhar L N. Direct vein graft reconstruction of the cavernous, petrous, and upper cervical internal carotid artery: lessons learned from 30 cases.  Neurosurgery. 1992;  30 732-743
• 5 Al‐Mefty O, Khalil N, Elwany M N, Smith R R. Shunt for bypass graft of the cavernous carotid artery: an anatomical and technical study.  Neurosurgery. 1990;  27(5) 721-727
• 6 Batzdorf U, Gregorius F K. Surgical exposure of the high cervical carotid artery: experimental study and review.  Neurosurgery. 1983;  13 657-661
• 7 Fist U P, Moldering D J, Seining A. Surgical therapy of internal carotid artery lesions of the skull base and temporal bone.  Otolaryngol Head Neck Surg. 1980;  88 548-554
• 8 Friedman W A, Day A L, Quisling R G, Sypert G W, Rhoton Jr A L. Cervical carotid dissecting aneurysms.  Neurosurgery. 1980;  7(3) 207-214
• 9 Sandmann W, Hennerici M, Aulich A, Kniemeyer H, Kremer K W. Progress in carotid artery surgery at the base of the skull.  J Vasc Surg. 1984;  1(6) 734-743
• 10 Shaha A, Phillips T, Scalea T et al.. Exposure of the internal carotid artery near the skull base: the posterolateral anatomic approach.  J Vasc Surg. 1988;  8(5) 618-622
• 11 Sundt Jr T M, Pearson B W, Piepgras D G, Houser O W, Mokri B. Surgical management of aneurysms of the distal extracranial internal carotid artery.  J Neurosurg. 1986;  64(2) 169-182
• 12 Virionis F D, Cano W G, Heilman C B. Microsurgical anatomy of the infratemporal fossa as viewed laterally and superiorly.  Neurosurgery. 1996;  39(4) 777-786
• 13 Fisher Jr D F, Clagett G P, Parker J I et al.. Mandibular subluxation for high carotid exposure.  J Vasc Surg. 1984;  1(6) 727-733
• 14 Sekhar L N, Schramm Jr V L, Jones N F et al.. Operative exposure and management of the petrous and upper cervical internal carotid artery.  Neurosurgery. 1986;  19(6) 967-982
• 15 Lougheed W M, Marshall B M, Hunter M, Michel E R, Sandwith-Smyth H. Common carotid to intracranial internal carotid bypass venous graft: technical note.  J Neurosurg. 1971;  34 114-118
• 16 Onesti S T, Solomon R A, Quest D O. Cerebral revascularization: a review.  Neurosurgery. 1989;  25(4) 618-629
• 17 Lang J. Skull Base and Related Structures. Atlas of Clinical Anatomy. Stuttgart; Schattauer 1995: 122-123
• 18 EC/IC Bypass Study Group . Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial.  N Engl J Med. 1985;  313(19) 1191-1200