Internal Maxillary Bypass for Complex Pediatric Aneurysms

Area of Science:

• Neurosurgery
• Pediatric Vascular Surgery
• Cerebrovascular Surgery

Background:

• Complex pediatric aneurysms (PAs) are rare and challenging vascular lesions.
• Limited data exists on surgical interventions, specifically bypass procedures, for complex PAs.

Purpose of the Study:

• To evaluate the efficacy and safety of internal maxillary artery-to-middle cerebral artery bypass using a radial artery graft for treating complex pediatric aneurysms.

Main Methods:

• Seven pediatric patients (age ≤18 years) with complex PAs underwent internal maxillary artery-to-middle cerebral artery bypass with radial artery graft.
• Bypass patency and aneurysm stability were assessed using intraoperative Doppler ultrasound, indocyanine green videoangiography, and postoperative angiography.
• Neurologic function was evaluated using the Modified Rankin Scale.

Main Results:

• The study included 7 pediatric patients with complex PAs (mean age 14.4 years, mean PA size 23.6 mm).
• Surgical approaches included proximal artery occlusion, bypass with excision, or combined methods.
• A 100% graft patency rate was observed during follow-up (mean 20 months), with excellent outcomes in 6 out of 7 patients.

Conclusions:

• Internal maxillary artery bypass is a crucial and effective technique for managing selected cases of complex pediatric aneurysms.
• The procedure demonstrated high graft patency and favorable outcomes in this pediatric cohort.