机构：[1]Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.[2]Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.[3]Department of Neurosurgery, Beijing Shijingshan Hospital, Beijing, China.[4]Department of Neurosurgery, The First Affiliated Hospital of University of South China, Hengyang, China.[5]Arkansas Neuroscience Institute, St. Vincent Hospital, Little Rock, Arkansas[6]Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China.
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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外文
PubmedID：
中科院(CAS)分区：
出版当年[2018]版：
大类|3 区医学
小类|3 区临床神经病学3 区外科
最新[2023]版：
大类|2 区医学
小类|2 区临床神经病学2 区外科
第一作者：
第一作者机构：[1]Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.[2]Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
通讯作者：
通讯机构：[1]Department of Neurosurgery, SanBo Brain Hospital, Capital Medical University, Beijing, China.[6]Department of Neurosurgery, Fuxing Hospital, Capital Medical University, Beijing, China.[*1]SanBo Brain Hospital, Capital Medical University, Beijing, China
推荐引用方式(GB/T 7714)：
Wang Long,Lu Shuaibin,Cai Li,et al.Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms.[J].Neurosurgical focus.2019,46(2):E10.doi:10.3171/2018.11.FOCUS18457.
APA：
Wang Long,Lu Shuaibin,Cai Li,Qian Hai,Tanikawa Rokuya&Shi Xiang'en.(2019).Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms..Neurosurgical focus,46,(2)
MLA：
Wang Long,et al."Internal maxillary artery bypass for the treatment of complex middle cerebral artery aneurysms.".Neurosurgical focus 46..2(2019):E10
