Internal Maxillary Bypass for Complex Pediatric Aneurysms

Wang, Long; Lu, Shuaibin; Qian, Hai; Shi, Xiaoyan

doi:10.1016/j.wneu.2017.04.055

Cited by 24 publications

(5 citation statements)

References 39 publications

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“…Compared with the intracranial insertion bypass, extracranial double-branch replantation of extracranial blood supply, or external carotid artery (ECA)-graft-MCA single-branch high-flow bypass previously, the core characteristic of this case's scheme is using the IMA as a high-flow donor artery for a seven-year-old child, which reflects the advantages of the IMA-RA-MCA bypass. In recent years, with the development of research and technical practice, the advantages of IMA as a high-flow bypass donor artery in the treatment of complex MCA arteries aneurysms have been well-established ( 7 ), and there have been many successful cases and case series reports ( 8 – 12 ), confirming that the IMA can be a safe and efficient high-flow donor artery. Compared with ECA, IMA has many advantages such as a single cranial incision, shorter distance from the intracranial recipient artery which reduces the length of the graft, thus reducing the risk of postoperative bypass vessel torsion, and the deeper location can effectively avoid compression, etc ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

et al. 2022

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BackgroundChildren's complex middle cerebral artery (MCA) aneurysm is a relatively rare occurrence. When the huge aneurysm is located in the MCA bifurcation with an inconspicuous neck and involving numerous arteries, intravascular interventional surgery or aneurysm clipping are often difficult treatment options. At this point, high flow bypass revascularization is necessary as a treatment to preserve cerebral blood flow. In recent years, the internal maxillary artery (IMA) has gradually become the mainstream donor artery of thw high flow bypass. We performed internal maxillary artery -radial artery-middle cerebral artery (IMA-RA-MCA) and superficial temporal artery-middle cerebral artery (STA-MCA) bypass as the treatment of a complex MCA bifurcation aneurysm in consideration of the patient's condition and the advantage of the IMA. According to the author, this case is the youngest reported case of IMA-RA-MCA bypass at present.Case DescriptionA male child, 7 years and 8 months, was admitted to the hospital due to “recurrent headache for more than 9 months,” DSA indicated that there was a large wide-necked aneurysm at the bifurcation of the right MCA M1 segment, with a size of about 1.16*1.58*1.32 cm. The inflow path of the aneurysm was in front of M1 bifurcation, and one outflow path originated from the aneurysm body, and another small outflow path attached to the aneurysm body. After completing the preoperative evaluation, an extended pterional approach with zygomatic osteotomy was performed to fully expose the aneurysm and IMA, harvesting the left radial artery at the same time, then a STA-MCA bypass, IMA-RA-MCA bypass, and aneurysm trapping were performed. postoperative re-examination showed that bypass vessels and the distal middle artery vessels were patent and the aneurysm disappeared, the child has no neurological dysfunction.ConclusionsIMA-RA-MCA bypass is an effective high-flow cerebral blood reconstruct scheme in the treatment of complex middle cerebral artery bifurcation aneurysms. This case can provide a reference for the surgical treatment of complex middle cerebral artery bifurcation aneurysms in children.

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Section: Discussionmentioning

confidence: 99%

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

et al. 2022

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“…In 2 patients, the confluent sellar-sphenoid cavity opened postoperatively and was packed with a small plug of muscle and pieces of fascia, and in 4 patients, the opened confluent paranasal sinus-intersellar turcica-middle cranial fossa was repaired with 7–0 nylon watertight microsuturing of the superficial fascia of the temporal muscle around the dural edge of the defective dural cavity. Before occlusion, patients received IV heparin (20–30 units/kilogram) to prevent postprocedural thrombosis of the graft vessel; immediate salvage strategies for IMA bypass have previously been published ( 9 , 10 ). Revascularization was performed after barbiturate protection and the provision of mild hypothermia.…”

Section: Methodsmentioning

confidence: 99%

Maximal Resection of Tumors Encasing the Internal Carotid Artery and Hindering Internal Carotid Artery Expansion Followed by Revascularization Surgery: A Series of Nine Cases at a Single Tertiary Center

Sun¹,

Wang²,

Shi³

et al. 2022

Front. Surg.

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PurposeCerebral reconstruction appears to play a diminished role in managing complex skull base tumors involving vital neurovascular structures.Materials and MethodsPatients with recurrent or progressive middle cranial fossa tumors treated by radical resection followed by extracranial-to-intracranial (EC-IC) bypass from 2014 to 2019 were included. Balloon test occlusion (BTO) was performed preoperatively.ResultsOverall, 9 patients (5 males, 4 females; mean age, 29.9 years) were enrolled. The lesions arose from the parasellar region (3), cavernous sinus (3), petroclival region (2), or orbital apex (1), and all encased the cavernous/petrous portion of the internal carotid artery. Before tumor resection, internal maxillary artery (IMA) bypass was performed for 7 patients, cervical EC-IC bypass was performed for 1 patient, and interposed superficial temporal artery (STA) bypass was performed for 1 patient. BTO failed in 8 patients and was tolerated by one patient. Intraoperative blood flow of the interposed graft was 79.7 ± 37.86 ml/min after IMA bypass, 190.6 ml/min following cervical EC-IC bypass and 75 ml/min after interposed STA bypass. All bypasses were patent on intraoperative indocyanine green angiography. Radical tumor resection was achieved in 5 patients (55.6%), and patency was confirmed postoperatively in 88.8% (8/9) of bypasses. Six patients showed favorable outcomes at discharge. At the 2-year follow-up, 7 patients (77.8%) had favorable outcomes (Karnofsky Performance Scale score>80). At the 1.5-year follow-up, one patient had died due to infarction; at the 3-year follow-up, another patient had developed tumor recurrence despite being asymptomatic.ConclusionCerebral bypass remains a vital tool for managing select middle cranial fossa tumors that invade or erode the surrounding neurovasculature or hinder carotid artery expansion and are difficult to resect.

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“…The techniques of performing IMA bypass have been described in our previous articles. 24,25,29,[32][33][34]36 Briefly, we approached the aneurysms using a frontotemporal craniotomy with zygomatic osteotomy. The radial artery (RA) was harvested and prepared before being anastomosed in an end-to-end fashion to the pterygoid segment of the IMA (I 2 ) by using 9-0 prolene.…”

Section: Bypass Technique and Perioperative Managementmentioning

confidence: 99%

“…As for the interposition graft of IMA bypass, the RA 24,25,[32][33][34]36 and forearm cephalic vein 12,13 have been used in clinical settings. Recently, preclinical studies focusing on STA trunk grafts have been comprehensively reported in the literature.…”

Section: The Role Of Ima Bypass In Cerebral Revascularizationmentioning

confidence: 99%

“…Recently, the internal maxillary artery (IMA) bypass, the only substantive modification of cerebral revascularization techniques, has gained momentum. 24,25,[32][33][34]36 This technique was heralded as a new "workhorse" in the field of high-flow bypass to replace conventional cervical artery bypass. 14,29 However, very limited data exist regarding the experiences with using this novel extracranial artery as a donor, especially in the territory of the MCA.…”

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confidence: 99%

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Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

Wang

Cai

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe rapid innovation of the endovascular armamentarium results in a decreased number of indications for a classic surgical approach. However, a middle cerebral artery (MCA) aneurysm remains the best example of one for which results have favored microsurgery over endovascular intervention. In this study, the authors aimed to evaluate the experience and efficacy regarding surgical outcomes after applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).METHODSAll IMA bypasses performed between January 2010 and July 2018 in a single-center, single-surgeon practice were screened.RESULTSIn total, 12 patients (9 males, 3 females) with CMCAAs managed by high-flow IMA bypass were identified. The mean size of CMCAAs was 23.7 mm (range 10–37 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 resected in 1 case. The radial artery was used as the graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n = 10), and all aneurysms were completely eliminated (83.3%, n = 10) or greatly diminished (16.7%, n = 2) from the circulation. Postoperative ischemia was detected in 2 patients as a result of graft occlusion, and 1 patient presenting with subarachnoid hemorrhage achieved improved modified Rankin Scale scores compared to the preoperative status but retained some neurological deficits. Therefore, neurological assessment at discharge showed that 9 of the 12 patients experienced 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), respectively. Although 2 grafts remained occluded, all aneurysms were isolated from the circulation, and no patient had an unfavorable outcome.CONCLUSIONSThe satisfactory result in the present study demonstrated that IMA bypass is a promising method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium. However, cases with intraoperative radical resection or inappropriate bypass recipient selection such as aneurysmal wall should be meticulously chosen with respect to the subtype of MCA aneurysm.

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Internal Maxillary Bypass for Complex Pediatric Aneurysms

Cited by 24 publications

References 39 publications

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

Internal Maxillary Artery-Radial Artery-Middle Cerebral Artery Bypass and STA-MCA Bypass for the Treatment of Complex Middle Cerebral Artery Bifurcation Aneurysm: A Case Report

Maximal Resection of Tumors Encasing the Internal Carotid Artery and Hindering Internal Carotid Artery Expansion Followed by Revascularization Surgery: A Series of Nine Cases at a Single Tertiary Center

Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms

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