Neurological Complications and Surgical Outcome in Patients with Anterior Choroidal Segment Aneurysms

Furtado, Sunil V.; Venkatesh, Prasanna K.; Hegde, Alangar S.

doi:10.3109/00207451003668390

Cited by 16 publications

(8 citation statements)

References 15 publications

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“…Due to the low incidence of AChA aneurysms, only 2 to 5% of intracranial aneurysms4,19), there are relatively few reports on the related outcomes of surgical and endovascular treatments, as summarized in Table 2 and 31,5,6,8-11,15-17,20), which only include studies of more than 10 individuals with a non-giant aneurysm published in a peer-reviewed journal.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of permanent AChA syndrome after surgical clipping of an AChA aneurysm has consistently been reported to range from 5.3% to 15.7%1,5,6,10,11,17,20). When compared with surgical series, endovascular series have a much lower incidence of AChA insufficiency, although only a few series have been reported8-10,15,16).…”

Section: Discussionmentioning

confidence: 99%

“…Notwithstanding, the surgical results can still be unsatisfactory due to inadvertent occlusion of the AChA, leading to a permanent AChA syndrome with an incidence of 5 to 16%1,5,6,10,17,20). Furthermore, the low incidence of AChA aneurysms has hampered the accumulation of surgical experience with infrequent publications on the surgical outcomes of AChA aneurysms.…”

Section: Introductionmentioning

confidence: 99%

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Anterior Choroidal Artery Aneurysm Surgery: Ischemic Complications and Clinical Outcomes Revisited

Lee

Park

2013

J Korean Neurosurg Soc

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ObjectiveSurgical 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.MethodsIdentification 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.ResultsAll 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).ConclusionIn 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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anterior Choroidal Artery Aneurysm Surgery: Ischemic Complications and Clinical Outcomes Revisited

Lee

Park

2013

J Korean Neurosurg Soc

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“…This syndrome presents with contralateral hemiplegia (often involv-ing face, arm, and leg), dysarthria, lethargy, and occasional sensory and vision loss. [4][5][6] Many factors influence the prognosis of patients with AChAA. This article retrospectively analyzes the clinical data of 2,095 patients with intracranial aneurysms from December 1997 to December 2018 in the Department of Neurosurgery, Affiliated Hospital of Qingdao University, 86 of whom had AChAAs accounting for 4.1%.…”

Section: Introductionmentioning

confidence: 99%

Microsurgical Treatment of 86 Anterior Choroidal Artery Aneurysms: Analysis of Factors Influencing the Prognosis

Feng

et al. 2020

J Neurol Surg A Cent Eur Neurosurg

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Purpose To explore factors affecting the prognosis of choroidal anterior artery aneurysm (AChAA) and provide a reference for improving the postoperative outcome. Methods The clinical data of 86 patients with AChAA who underwent treatment by a single surgeon were collected and analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were conducted to examine 12 factors that possibly affected outcome. Results The five factors that affected the patient outcomes were times of subarachnoid hemorrhage (SAH), characteristics of SAH on computed tomography (CT), Hunt-Hess grade, aneurysm size, and presence or absence of postoperative complications. Characteristics of SAH on CT (odds ratio [OR]: 3.727; p = 0.000; 95% confidence interval [CI], 1.850–7.508), aneurysm size (OR: 6.335; p = 0.000; 95% CI, 2.564–15.647), and presence or absence of postoperative complications (OR: 4.141; p = 0.000; 95% CI, 1.995–8.599) were independent risk factors influencing the prognosis. In addition, the incidence of postoperative ischemia (caused by anterior choroidal artery syndrome) is related to the aneurysm emitting part and presence or absence of intraoperative rupture. Conclusions The analysis of characteristics of SAH on CT, aneurysm size, and presence or absence of postoperative complications can roughly determine the outcome of patients with AChAAs.

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“…Few studies exist that address the necessity of follow-up angiography and the efficacy of clip ligation. 5,21 Although postoperative angiography can confirm initial aneurysm obliteration, the potential for clip failure and aneurysm recurrence or regrowth still remains. Recent data suggest that neither endovascular nor surgical treatments can fully eliminate the risk of aneurysm recurrence, residua growth, or SAH.…”

Section: Discussionmentioning

confidence: 99%

A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation

Brown

Parish

Guandique

et al. 2017

JNS

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OBJECTIVE With the recent evolution of endovascular therapies, objective evaluation of the efficacy of clip ligation for cerebral aneurysms should be performed. This study was undertaken to evaluate the durability of microsurgical clip ligation, identify risk factors for recurrence, and assess the need for long-term follow-up imaging. METHODS A retrospective review of medical records identified 616 consecutive patients (156 male and 460 female patients; mean age 48.4 ± 12.4 years; range 6-90 years) who underwent microsurgical clip ligation and follow-up imaging at least 1 year after discharge between 1990 and 2010 at our institution. Of a total of 926 aneurysms in 616 patients, 758 aneurysms were microsurgically clip-ligated. At presentation, 431 of these aneurysms were ruptured and 327 aneurysms were unruptured. All patients underwent postoperative baseline imaging within the 1st month of their operation. A logistic regression analysis was performed to identify which variables are more likely to predict recurrence. RESULTS Late follow-up angiographic imaging was obtained at a mean of 7.2 ± 4.7 years postdischarge (median 5.7 years; range 1-23 years). Of the 699 clipped aneurysms without residua, late follow-up angiography revealed only 1 (0.14%) recurrent aneurysm. Of the 59 residual aneurysms that remained after initial clip ligation on early postoperative imaging, 8 (13.6%) demonstrated growth. All of these aneurysms required treatment. None of the recurrences were due to broken or delayed displacement of clips. A total of 111 patients presented with multiple aneurysms. De novo aneurysm formation occurred in 8 (0.97%) patients, all of whom initially presented with multiple aneurysms. CONCLUSIONS This study provides additional evidence to support the long-term efficacy of aneurysm clip ligation. The chance of aneurysm recurrence after complete clip ligation is very small. However, there is a regrowth risk of 1.83% per year for aneurysm remnants after incomplete clip ligation. These findings support the necessity for continued followup, late angiographic imaging, and the potential need for further intervention of incompletely ligated aneurysms. Furthermore, completely clip-ligated aneurysms may not require additional surveillance imaging unless multiple aneurysms were evident at presentation.

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Neurological Complications and Surgical Outcome in Patients with Anterior Choroidal Segment Aneurysms

Cited by 16 publications

References 15 publications

Anterior Choroidal Artery Aneurysm Surgery: Ischemic Complications and Clinical Outcomes Revisited

Anterior Choroidal Artery Aneurysm Surgery: Ischemic Complications and Clinical Outcomes Revisited

Microsurgical Treatment of 86 Anterior Choroidal Artery Aneurysms: Analysis of Factors Influencing the Prognosis

A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation

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