Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Anterior Choroidal Artery Aneurysm Surgery : Ischemic Complications and Clinical Outcomes Revisited

  • Lee, Young-Sup (Department of Neurosurgery, Cardiocerebrovascular Center, Kyungpook National University) ;
  • Park, Jaechan (Department of Neurosurgery, Cardiocerebrovascular Center, Kyungpook National University)
  • Received : 2013.03.23
  • Accepted : 2013.08.05
  • Published : 2013.08.28
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Abstract

Objective : Surgical results for anterior choroidal artery (AChA) aneurysms have previously been reported as unsatisfactory due to inadvertent occlusion of the AChA, while the low incidence of AChA aneurysms hampers the accumulation of surgical experience. The authors reviewed their related surgical experience to document the ischemic complications and surgical outcomes. Methods : Identification of the AChA at its origin by rigorous visual scrutiny, careful microdissection, and meticulous clip placement to avoid the AChA origin are all crucial surgical maneuvers. A retrospective review of a surgical series of 62 consecutive cases of an AChA aneurysm between 2004 and 2012 was performed. Results : All patients, except for five (8.1%) with a small residual neck, showed complete aneurysm obliteration in postoperative angiographic evaluations. There was no incidence of procedure-related permanent AChA syndrome or oculomotor nerve palsy, while three (4.8%) patients suffered from transient AChA syndrome. The clinical outcomes [the 3-month modified Rankin Scale (mRS)] of the patients were related to their preoperative World Federation of Neurologic Surgeons (WFNS) grade. As regards the 3-month mRS, significant differences were found between patients with an unruptured aneurysm (WFNS grade 0; n=20), good-grade subarachnoid hemorrhage (WFNS grade 1-3; n=30), and poor-grade subarachnoid hemorrhage (WFNS grade 4-5; n=4). Conclusion : In surgical treatment of AChA aneurysms, a risk of AChA insufficiency can be minimized by taking every precaution to preserve the AChA patency and intraoperative monitoring. In addition, the surgical outcome is primarily determined by the preoperative clinical state.

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References

  1. Cho MS, Kim MS, Chang CH, Kim SW, Kim SH, Choi BY : Analysis of Clip-induced Ischemic Complication of Anterior Choroidal Artery Aneurysms. J Korean Neurosurg Soc 43 : 131-134, 2008 https://doi.org/10.3340/jkns.2008.43.3.131
  2. Dashti R, Laakso A, Niemelä M, Porras M, Hernesniemi J : Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms : the Helsinki experience. Surg Neurol 71 : 543-550; discussion 550, 2009 https://doi.org/10.1016/j.surneu.2009.01.027
  3. Fischer G, Stadie A, Oertel JM : Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery. Acta Neurochir (Wien) 152 : 1519-1525, 2010 https://doi.org/10.1007/s00701-010-0723-5
  4. Flamm ES : Other aneurysms of the internal carotid artery in Wilkins RH, Rengachary SS (eds) : Neurosurgery. New York : McGraw-Hill, 1996, pp2301-2310
  5. Friedman JA, Pichelmann MA, Piepgras DG, Atkinson JL, Maher CO, Meyer FB, et al. : Ischemic complications of surgery for anterior choroidal artery aneurysms. J Neurosurg 94 : 565-572, 2001 https://doi.org/10.3171/jns.2001.94.4.0565
  6. Furtado SV, Venkatesh PK, Hegde AS : Neurological complications and surgical outcome in patients with anterior choroidal segment aneurysms. Int J Neurosci 120 : 291-297, 2010 https://doi.org/10.3109/00207451003668390
  7. Irie T, Yoshitani K, Ohnishi Y, Shinzawa M, Miura N, Kusaka Y, et al. : The efficacy of motor-evoked potentials on cerebral aneurysm surgery and new-onset postoperative motor deficits. J Neurosurg Anesthesiol 22 : 247-251, 2010 https://doi.org/10.1097/ANA.0b013e3181de4eae
  8. Kang HS, Kwon BJ, Kwon OK, Jung C, Kim JE, Oh CW, et al. : Endovascular coil embolization of anterior choroidal artery aneurysms. Clinical article. J Neurosurg 111 : 963-969, 2009 https://doi.org/10.3171/2009.4.JNS08934
  9. Kim BM, Kim DI, Chung EC, Kim SY, Shin YS, Park SI, et al. : Endovascular coil embolization for anterior choroidal artery aneurysms. Neuroradiology 50 : 251-257, 2008 https://doi.org/10.1007/s00234-007-0331-0
  10. Kim BM, Kim DI, Shin YS, Chung EC, Kim DJ, Suh SH, et al. : Clinical outcome and ischemic complication after treatment of anterior choroidal artery aneurysm : comparison between surgical clipping and endovascular coiling. AJNR Am J Neuroradiol 29 : 286-290, 2008 https://doi.org/10.3174/ajnr.A0806
  11. Li J, Mukherjee R, Lan Z, Liu Y, He M : Microneurosurgical management of anterior choroidal artery aneurysms : a 16-year institutional experience of 102 patients. Neurol Res 34 : 272-280, 2012 https://doi.org/10.1179/1743132812Y.0000000008
  12. Park J, Kang DH, Chun BY : Superciliary keyhole surgery for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy : maximizing symptomatic resolution and minimizing surgical invasiveness. J Neurosurg 115 : 700-706, 2011 https://doi.org/10.3171/2011.5.JNS102087
  13. Park J, Woo H, Kang DH, Sung JK, Kim Y : Superciliary keyhole approach for small unruptured aneurysms in anterior cerebral circulation. Neurosurgery 68 (2 Suppl Operative) : 300-309; discussion 309, 2011
  14. Park JH, Kim JE, Sheen SH, Jung CK, Kwon BJ, Kwon OK, et al. : Intraarterial abciximab for treatment of thromboembolism during coil embolization of intracranial aneurysms : outcome and fatal hemorrhagic complications. J Neurosurg 108 : 450-457, 2008 https://doi.org/10.3171/JNS/2008/108/3/0450
  15. Piotin M, Mounayer C, Spelle L, Williams MT, Moret J : Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol 25 : 314-318, 2004
  16. Senturk C, Bandeira A, Bruneau M, Dewindt A, Balériaux D, De Witte O, et al. : Endovascular treatment of anterior choroidal artery aneurysms. J Neuroradiol 36 : 228-232, 2009 https://doi.org/10.1016/j.neurad.2008.12.002
  17. Shibata Y, Fujita S, Kawaguchi T, Hosoda K, Komatsu H, Tamaki N : Use of microvascular Doppler sonography in aneurysm surgery on the anterior choroidal artery. Neurol Med Chir (Tokyo) 40 : 30-35; discussion 35-37, 2000 https://doi.org/10.2176/nmc.40.30
  18. Suzuki K, Kodama N, Sasaki T, Matsumoto M, Konno Y, Sakuma J, et al. : Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery. J Neurosurg 98 : 507-514, 2003 https://doi.org/10.3171/jns.2003.98.3.0507
  19. Yasargil MG : Microneurosurgery : Clinical Considerations, Surgery of the Intracranial Aneurysms and Results. New York : Thieme, Vol 2, 1984, pp99-108
  20. Yasargil MG, Yonas H, Gasser JC : Anterior choroidal artery aneurysms : their anatomy and surgical significance. Surg Neurol 9 : 129-138, 1978

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