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Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis

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Abstract

The utilization of the internal maxillary artery (IMAX) in subcranial-intracranial bypass for revascularization in complex aneurysms, tumors, or refractory ischemia shows promise. However, robust evidence concerning its outcomes is lacking. Hence, the authors embarked on a systematic review with pooled analysis to elucidate the efficacy of this approach. We systematically searched PubMed, Embase, and Web of Science databases following PRISMA guidelines. Included articles used the IMAX as a donor vessel for revascularizing an intracranial area and reported at least one of the following outcomes: patency, complications, or clinical data. Favorable outcomes were defined as the absence of neurologic deficits or improvement in the baseline condition. Complications were considered any adverse event directly related to the procedure. Out of 418 retrieved articles, 26 were included, involving 183 patients. Among them, 119 had aneurysms, 41 experienced ischemic strokes (transient or not), 2 had arterial occlusions, and 3 had neoplasia. Furthermore, 91.8% of bypasses used radial artery grafts, and 87.9% revascularized the middle cerebral artery territory. The median average follow-up period was 12 months (0.3–53.1). The post-operation patency rate was 99% (95% CI: 97–100%; I2=0%), while the patency rate at follow-up was 82% (95% CI: 68–96%; I2=77%). Complications occurred in 21% of cases (95% CI: 9–32%; I2=58%), with no significant procedure-related mortality in 0% (95% CI: 0–2%; I2=0%). Favorable outcomes were observed in 88% of patients (95% CI: 81–96%; I2=0%), and only 3% experienced ischemia (95% CI: 0–6%; I2=0%). The subcranial-intracranial bypass with the IMAX shows excellent postoperative patency and considerable favorable clinical outcomes. While complications exist, the procedure carries a minimal risk of mortality. However, long-term patency presents heterogeneous findings, warranting additional research.

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Abbreviations

IMAX:

Internal Maxillary Artery

RAG:

Radial Artery Graft

STA:

Superficial Temporal Artery

SC-IC:

Subcranial-Intracranial

MCA:

Middle Cerebral Artery

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Authors and Affiliations

  1. Department of Neurosurgery, State University of Ponta Grossa, Uvaranas Campus - General Carlos Cavalcanti Avenue, 4748, Ponta Grossa, Paraná, Brazil

    Leonardo de Barros Oliveira, Pedro Henrique Cieslak & Leonardo C. Welling

  2. Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

    Guilherme Nunes Marques, Sávio Batista & Filipi Fim Andreão

  3. Max Planck University Center, Indaiatuba, São Paulo, Brazil

    Lucca B. Palavani

  4. Universidad Peruana Cayetano Heredia, Lima, Peru

    Jhon E. Bocanegra-Becerra

  5. University of São Paulo, São Paulo, São Paulo, Brazil

    Raphael Bertani, Nicollas Nunes Rabelo & Eberval Gadelha Figueiredo

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  1. Leonardo de Barros Oliveira
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Oliveira, L.d.B., Cieslak, P.H., Marques, G.N. et al. Maxillary artery utilization in subcranial-intracranial bypass procedures: a comprehensive systematic review and pooled analysis. Neurosurg Rev 47, 41 (2024). https://doi.org/10.1007/s10143-023-02265-0

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