1126. Internal Maxillary Artery Bypass for the Treatment of Complex Middle Cerebral Aneurysms

Authors: Long Wang, MD, PhD; Long Wang (Phoenix, AZ)

Introduction: The rapid innovation of endovascular armamentarium results in decreased number of indications for a classic surgical approach. However, the middle cerebral artery (MCA) remains the best example of an aneurysm for which results favored microsurgery over endovascular intervention. Methods: To evaluate the authors’ experience and efficacy regarding surgical outcomes of applying internal maxillary artery (IMA) bypass for complex MCA aneurysms (CMCAAs). 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 to 37 mm) with a mean age of 31.7 years (range, 14-56 years). The aneurysms were proximal occluded in 8 cases, complete trapping in 3 cases and totally amputated in 1 case. Radial artery was utilized as graft vessel in all cases. At discharge, the graft patency rate was 83.3% (n=10) and all aneurysms were complete eliminated (83.3%, n=10) or great diminishment (16.7%, n=2) from the circulation. Postoperative ischemia was detected in 2 patients as results of graft occlusion and one patient presented with subarachnoid hemorrhage that had improved mRS scores compared to preoperative status remains neurologically 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). Despite two grafts remained occlude, all the aneurysms were eliminated from the circulation and no patients achieved unfavorable outcomes. Conclusion: The satisfactory result of the present study demonstrated IMA bypass is a promising method for the treatment of CMCAAs and should kept in the armamentarium of neurosurgeons. However, the intraoperatively radical resection or inappropriate recipient selection should be meticulously chosen in the subtype of MCA aneurysm.