Internal Maxillary Bypass for Complex Pediatric Aneurysms.

Internal Maxillary Bypass for Complex Pediatric Aneurysms.

World Neurosurg. 2017 Apr 19;:

Authors: Wang L, Lu S, Qian H, Shi X

Abstract
BACKGROUND: Complex pediatric aneurysms (PAs) are an unusual clinicopathologic entity, and data remain limited regarding the use of a bypass procedure to treat this formidable disorder.
METHODS: Internal maxillary artery (IMA) to middle cerebral artery (MCA) bypass with radial artery graft (RAG) was utilized to isolate PAs. Bypass patency and aneurysm stability were evaluated using intraoperative Doppler ultrasound, indocyanine green videoangiography and postoperative angiography. The modified Rankin Scale (mRS) was used to assess neurological function.
RESULTS: Over a 5-year period, 7 pediatric patients (aged 18 years or younger) were included in our analysis. The age of the patients ranged from 12 to 18 years (mean, 14.4 years), and the mean size of the PAs was 23.6 mm (range: 9 to 37 mm) with all of the cases presenting complex characteristics. Three PAs were treated using proximal artery occlusion (PAO), 2 were completely excised following an aneurysmal distal IMA bypass, and a combined PAO and aneurysm excision procedure was performed in the 2 remaining cases. The measured intraoperative blood flow ranged from 40.0 to 90.8 ml/min (mean, 61.6 ml/min). The graft patency rate was 100% during the postoperative recovery and at the last follow-up (mean, 20 months; range: 7-45 months). Excellent outcomes were observed in all patients except for one who died of multiple organ failure.
CONCLUSIONS: IMA bypass is an essential technique for the treatment of selected cases of complex PAs.

PMID: 28433837 [PubMed - as supplied by publisher]

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