Internal Maxillary Bypass for Complex Pediatric Aneurysms

Abstract

Complex pediatric aneurysms (PAs) are an unusual clinicopathologic entity. Data regarding the use of a bypass procedure to treat complex PAs are limited. Internal maxillary artery-to-middle cerebral artery bypass with radial artery graft was used to isolate PAs. Bypass patency and aneurysm stability were evaluated using intraoperative Doppler ultrasound, indocyanine green videoangiography, and postoperative angiography. Modified Rankin Scale was used to assess neurologic function. Over a 5-year period, 7 pediatric patients (≤18 years old) were included in our analysis. Mean age of patients was 14.4 years (range, 12-18 years), and mean size of PAs was 23.6 mm (range, 9-37 mm). All cases manifested with complex characteristics. Proximal artery occlusion was performed in 3 cases, complete excision following aneurysmal distal internal maxillary artery bypass was performed in 2 cases, and combined proximal artery occlusion and aneurysm excision was performed in the 2 remaining cases. Mean intraoperative blood flowwas 61.6 mL/minute (range, 40.0-90.8 mL/minute). Graft patency rate was 100% during postoperative recovery and at the last follow-up examination (mean, 20 months; range, 7-45 months). All patients had excellent outcomes except for 1 patient who died of multiple-organ failure. Internal maxillary artery bypass is an essential technique for treatment of selected cases of complex PAs.