Vrionis F D, Cano W G, Heilman C B
Department of Neurosurgery, Tufts University School of Medicine, Boston, Massachusetts, USA.
Neurosurgery. 1996 Oct;39(4):777-85; discussion 785-6. doi: 10.1097/00006123-199610000-00027.
Benign tumors involving cavernous sinus, trigeminal nerve, and middle cranial fossa occasionally extend to the infratemporal fossa (ITF). In this study, we describe the microsurgical anatomy and dissection of the ITF, as viewed laterally and superiorly. We also describe a new bypass graft to the supraclinoid internal carotid artery using the internal maxillary artery (IMA), which is found in the ITF.
Twelve cadaver specimens were used. Dissection required zygomatic arch osteotomy, downward displacement of the temporalis muscle, extensive subtemporal craniectomy, and mild elevation of the temporal lobe together with the dura.
The anatomic relationships between the lateral and medial pterygoid muscles and the neurovascular bundle of the ITF are demonstrated. The neurovascular bundle contains the IMA, which runs horizontally, and the main branches of the mandibular nerve, which run vertically. The course and anatomic variations of the IMA and inferior alveolar, lingual, auriculotemporal, and buccal nerves are shown. The distal IMA was quite tortuous and, when the artery straightened, we were able to perform a tension-free in situ IMA graft to the supraclinoid carotid artery in 9 of 12 specimens.
Knowledge of the anatomy of the ITF is a prerequisite for tumor resection in this area. The IMA may serve as a bypass graft to the supraclinoid internal carotid artery if the cavernous or petrous carotid artery is involved by tumor and needs to be sacrificed.
累及海绵窦、三叉神经和中颅窝的良性肿瘤偶尔会延伸至颞下窝（ITF）。在本研究中，我们描述了从外侧和上方观察到的ITF的显微外科解剖结构及解剖方法。我们还描述了一种利用在ITF中发现的上颌内动脉（IMA）对床突上段颈内动脉进行的新型搭桥移植术。
使用12具尸体标本。解剖需要进行颧弓截骨术、颞肌向下移位、广泛的颞下颅骨切除术以及颞叶与硬脑膜一起轻度抬高。
展示了翼内肌和翼外肌与ITF神经血管束之间的解剖关系。神经血管束包含水平走行的IMA以及垂直走行的下颌神经的主要分支。显示了IMA以及下牙槽神经、舌神经、耳颞神经和颊神经的走行及解剖变异。IMA远端相当迂曲，当动脉变直时，在12个标本中有9个我们能够在无张力的情况下将IMA原位移植至床突上段颈动脉。
了解ITF的解剖结构是该区域肿瘤切除的前提条件。如果海绵窦段或岩骨段颈动脉被肿瘤累及且需要牺牲时，IMA可作为床突上段颈内动脉的搭桥移植血管。
