Objective: To evaluate the authors’ experience and efficacy regarding surgical outcomes of applying
internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs).
Methods: All IMA bypasses between January 2010 and July 2018 in a single-center, single surgeon’s
practice were screened.
Results: In 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 amputated in 1 case. The
radial artery was utilized 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 one patient presenting with subarachnoid hemorrhage
achieved improved mRS scores compared with the preoperative status but retained some
neurological deficits. Therefore, neurological assessment at discharge showed that
9 out of 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). Although two grafts remained occluded, all
the aneurysms were isolated from the circulation, and no patient had an unfavorable
outcome.
Conclusion: The satisfactory result of the present study demonstrated that IMA bypass is a promising
method for the treatment of CMCAAs and should be maintained in the neurosurgical armamentarium
of neurosurgeons. However, cases with intraoperative radical resection or inappropriate
recipient selection should be meticulously chosen with respect to the subtype of MCA
aneurysm.
