Article
The “SHI” internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms
Der „SHI“-Bypass für die obere Kieferarterie für die Behandlung komplexer Aneurysmen der mittleren Hirnarterie
Search Medline for
Authors
-
Long Wang
- SanBo Brain Hospital, Capital Medical University, Neurosurgery, Beijing, China
| Published: | May 8, 2019 |
|---|
Outline
Text
Objective: The rapid innovation of endovascular treatment forms results in the decreased number of indications for a classic surgical approach. However, the middle cerebral artery (MCA) remains the best example of an aneurysm for which results have favored microsurgery over endovascular intervention. In this study, the authors aim to evaluate the experience and efficacy of surgical outcomes when an internal maxillary artery (IMA) bypass is used in cases of complex MCA aneurysms (CMCAAs).
Methods: All IMA bypasses between January 2010 and July 2018 in a single-center, single neurosurgeon’s practice were screened.
Results: A total of 12 patients (9 males, 3 females) were identified in whom CMCAAs were managed by high-flow IMA bypass. The mean size of CMCAAs was 23.7 mm (range: 10 to 37 mm), and the patients had a mean age of 31.7 years (range, 14–56 years). The aneurysms were proximally occluded in 8 cases, completely trapped in 3 cases and completely amputated in 1 case. The radial artery was utilized as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n=10), and all aneurysms were completely eliminated from the circulation (83.3%, n=10) or greatly diminished (16.7%, n=2). Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and one patient presenting with subarachnoid hemorrhage achieved improved mRS scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 out of 12 patients had unremarkable outcomes. The mean interval time from bypass to angiographic and clinical follow-up was 28.7 months (range, 2–74 months) and 53.1 months (range, 19–82 months). Although two grafts remained occluded, all the aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.
Conclusion: The satisfactory result of the present study demonstrated that an IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium of neurosurgeons. However, cases with intraoperative radical resection or inappropriate recipient selection should be meticulously chosen with respect to the subtype of MCA aneurysm.
