Introduction: The maxillary artery (MA) supplies the infratemporal fossa, dura-mater, eustachian tube, paranasal sinuses, orbit and middle ear. With the advent of minimally invasive techniques including endoscopic, percutaneous and endovascular approaches, the understanding of the vascular micro-anatomy of this artery at the base of the skull including is paramount.
Methods: Six cadaveric heads were injected with red latex. The arteries and surrounding structures were dissected and studied using microsurgical techniques. In addition twenty CT angiograms (3D reconstructions) of actual patients were studied and the MA course was compared to the anatomical dissection findings.
Results: Two main variants are encountered according to its lateral or medial course around the LPM. In the middle variant the meningeal artery and the accessory meningeal artery originates directly from the MA however the inferior alveolar artery and the deep posterior temporal artery are born from a single trunk. In the lateral variant is exactly the opposite the middle meningeal and the accessory meningeal arteries share a single common trunk whereas the inferior alveolar artery and the deep posterior temporal artery are born separately.
The course of the maxillary artery was found to be lateral to the LPM in 21 CTA sides (52.5%) and medial to the LPM in 19 sides (47.5%). After evaluating the side congruency, 9 cases (45%) were found to have the medial type and 10 (50%) the lateral configuration as a mirror image along the contralateral side. In one case (5%) one side had a lateral variant and the other a medial variant.
Conclusions: Each variant has a different branching pattern and is not necessarily a mirror image of the contralateral side. MA CTA with 3D bone reconstruction is recommended in cases such as ICA-ECA bypass or transforamen ovale for trigeminal neuralgia procedures to predict their feasibility.
Patient Care: Increase anatomical awareness and decrease potential complications.
Learning Objectives: Understand the different course and branching of the MA as well as its meaning in minimal invasive procedures.