Internal Maxillary Bypass for Complex Pediatric Aneurysms
Long Wang1, Shuaibin Lu1, Hai Qian2
1Department of Neurosurgery, Fu Xing Hospital, Capital Medical University, Beijing, China.
Insights
Internal maxillary artery bypass effectively treats complex pediatric aneurysms (PAs). This bypass procedure demonstrated a 100% graft patency rate, offering a promising surgical option for these rare cases.
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.
Background:
Complex pediatric aneurysms (PAs) are an unusual clinicopathologic entity. Data regarding the use of a bypass procedure to treat complex PAs are limited.
Methods:
Internal maxillary artery-to-middle cerebral artery bypass with radial artery graft was used to isolate PAs. Bypass patency and aneurysm stability were evaluated using intraoperative Doppler ultrasound, indocyanine green videoangiography, and postoperative angiography. Modified Rankin Scale was used to assess neurologic function.
Results:
Over a 5-year period, 7 pediatric patients (≤18 years old) were included in our analysis. Mean age of patients was 14.4 years (range, 12-18 years), and mean size of PAs was 23.6 mm (range, 9-37 mm). All cases manifested with complex characteristics. Proximal artery occlusion was performed in 3 cases, complete excision following aneurysmal distal internal maxillary artery bypass was performed in 2 cases, and combined proximal artery occlusion and aneurysm excision was performed in the 2 remaining cases. Mean intraoperative blood flow was 61.6 mL/minute (range, 40.0-90.8 mL/minute). Graft patency rate was 100% during postoperative recovery and at the last follow-up examination (mean, 20 months; range, 7-45 months). All patients had excellent outcomes except for 1 patient who died of multiple-organ failure.
Conclusions:
Internal maxillary artery bypass is an essential technique for treatment of selected cases of complex PAs.
Related Concept Videos
01:10The Arch of Aorta
Encircling the heart, the coronary arteries form a ring-like structure before...
01:26Aneurysm III: Interprofessional Care
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:19Anastomoses
Anastomoses can be formed at arterial, venous, and lymphatic vessels.
Arterial Anastomosis: These occur between arteries. They...