Surgical Treatment of 127 Anterior Choroidal Artery Aneurysms A Cohort Study of Resultant Ischemic Complications

Bohnstedt, Bradley N.; Kemp, William J.; Li, Yiping; Payner, Troy D.; Horner, Terry G.; Leipzig, Thomas J.; Cohen-Gadol, Aaron

doi:10.1227/neu.0000000000000131

Cited by 37 publications

(12 citation statements)

References 17 publications

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“…Causes of the AChA syndrome after surgery mainly include excessive turbulence of blood vessels during surgery, thromboembolism of the AChA and its branches, edema, clip displacement, vasospasm, and reduction of the collateral blood supply. 12,[15][16][17][18] In recent years, many authors have used a variety of methods for detection of accidental AChA obliteration by the clip: intraoperative angiography, muscle motor evoked potentials monitoring 19 ; and intraoperative micro Doppler sonography.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…reported that ischemic complications stemming from surgical treatment of AChA aneurysms are most closely associated with a higher frequency of temporary clip applications for proximal control. [ 4 ] To preserve the AChA and avoid severe hemiparesis, monitoring with ICG-VAG and MEP is very useful. ICG-VAG is a safe and effective method that provides necessary information for modifying clip placement immediately.…”

Section: Discussionmentioning

confidence: 99%

Comparative outcome analysis of anterior choroidal artery aneurysms treated with endovascular coiling or surgical clipping

Aoki¹,

Hirohata²,

Noguchi³

et al. 2016

Surg Neurol Int

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Background:Treatment of anterior choroidal artery (AChA) aneurysms with endovascular coiling or surgical clipping may increase the risk of ischemic complications owing to the critical territory supplied by the AChA. We analyzed the surgical results of endovascular coiling and surgical clipping for AChA aneurysms performed in a single institution, as well as the role of indocyanine green-videoangiography (ICG-VAG) and motor-evoked potential (MEP).Methods:We analyzed 50 patients (51 aneurysms; 21 men, 29 women; mean age: 58 years) including 25 with subarachnoid hemorrhage treated with endovascular coiling or surgical clipping between April 1990 and October 2013. The complication rates and clinical outcomes of the coil group (mean follow-up: 61 months) and the clip group (mean follow-up: 121 months) were analyzed with a modified Rankin scale.Results:The overall clinical outcome of the coil group (95%) was better than that of the clip group (85%). Especially, the outcomes in the coil group were better in the first investigated period (1990–2007) (P < 0.05). However, after the introduction of ICG-VAG and MEP, the outcomes in the clip group improved significantly (P = 0.005), and treatment-related complications decreased from 20 to 4.7%. Eleven aneurysms (coil group: 8, clip group: 3) showed small neck remnants but no remarkable regrowth, except for 1 case during the mean follow-up period of 91 months.Conclusions:Surgical clipping of AChA aneurysms has become safer because of ICG-VAG and MEP monitoring. Coiling and clipping of AChA aneurysms showed good and comparable outcomes with these monitoring methods.

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“…Compared with clipping, coiling AChA aneurysms had a significantly lower incidence of AChA infarction 27 . For instance, in a study performed by Bohnstedt et al in 2013, the ischemic complication rate following surgical treatment of AChA aneurysms was 12%, whereas coiling AChA aneurysms as an alternative to clipping was associated with a 5.5% risk of ischemia 28 .…”

Section: Aneurysmmentioning

confidence: 99%

Clinical importance of the anterior choroidal artery: a review of the literature

Xu¹,

Zhao²,

Yu³

2018

Int. J. Med. Sci.

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The anterior choroidal artery (AChA) is a critical artery in brain physiology and function. The AChA is involved in many diseases, including aneurysm, brain infarct, Moyamoya disease (MMD), brain tumor, arteriovenous malformation (AVM), etc. The AChA is vulnerable to damage during the treatment of these diseases and is thus a very important vessel. However, a comprehensive systematic review of the importance of the AChA is currently lacking. In this study, we used the PUBMED database to perform a literature review of the AChA to increase our understanding of its role in neurophysiology. Although the AChA is a small thin artery, it supplies an extremely important region of the brain. The AChA consists of cisternal and plexal segments, and the point of entry into the choroidal plexus is known as the plexal point. During treatment for aneurysms, tumors, AVM or AVF, the AChA cisternal segments should be preserved as a pathway to prevent the infarction of the AChA target region in the brain. In MMD, a dilated AChA provides collateral flow for posterior circulation. In brain infarcts, rapid treatment is necessary to prevent brain damage. In Parkinson disease (PD), the role of the AChA is unclear. In trauma, the AChA can tear and result in intracranial hematoma. In addition, both chronic and non-chronic branch vessel occlusions in the AChA are clinically silent and should not deter aneurysm treatment with flow diversion. Based on the data available, the AChA is a highly essential vessel.

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Surgical Treatment of 127 Anterior Choroidal Artery Aneurysms A Cohort Study of Resultant Ischemic Complications

Cited by 37 publications

References 17 publications

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

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

Comparative outcome analysis of anterior choroidal artery aneurysms treated with endovascular coiling or surgical clipping

Clinical importance of the anterior choroidal artery: a review of the literature

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