J Neurol Surg B Skull Base 2019; 80(S 01): S1-S244
DOI: 10.1055/s-0039-1679515
Oral Presentations
Georg Thieme Verlag KG Stuttgart · New York

Internal Maxillary Artery Bypass for the Treatment of Complex Middle Cerebral Aneurysms

Long Wang
1   Capital Medical University, SanBo Brain Hospital, Beijing, China
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2019 (online)

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    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.


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    No conflict of interest has been declared by the author(s).