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

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

doi: 10.1227/NEU.0000000000000131
Research-Human-Clinical Studies

BACKGROUND: The anterior choroidal artery (AChA) supplies important areas of the nervous system, particularly the posterior limb of the internal capsule and optic radiation. Treatment of AChA aneurysms poses particular challenges because of the complex anatomy of the aneurysm associated with the relatively small diameter of AChAs, making preservation of the parent vessel during clip ligation or endosaccular coiling challenging.

OBJECTIVE: To investigate the incidence and features of ischemia in treatment of AChA aneurysms.

METHODS: A prospectively maintained database of patients who underwent treatment of aneurysms from 1985 to 2011 was queried to find patients with AChA aneurysms. Age, sex, Hunt and Hess grade, treatment modality, and complications were analyzed by use of the unpaired Student t test and Fisher exact test.

RESULTS: One hundred twenty-two patients harbored 127 AChA aneurysms, and 67% (82 of 122) had multiple aneurysms. Treatment included 112 microsurgical clip ligations, 8 endosaccular coil embolizations, 5 aneurysmal wrappings, and 2 surgical explorations. Complications developed in 53% (67 of 127) of AChA aneurysms. Postoperative ischemia occurred in 12% (15 of 127) of treated aneurysms. The number of temporary clip applications was most closely associated with postoperative ischemia. Glasgow Outcome Scale scores of 4 or 5 were obtained by 78% at discharge, 89% at 6 months, and 85% at 1 year.

CONCLUSION: The ischemic complication rate from surgical treatment of AChA aneurysms is most closely associated with higher frequency of temporary clip applications for proximal control and may be lower than previously reported. Supplementary intraoperative tools and limitation of vessel manipulation should be used to improve outcomes.

ABBREVIATIONS: AChA, anterior choroidal artery

ICG, indocyanine green

SAH, subarachnoid hemorrhage

Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana

Correspondence: Aaron A. Cohen-Gadol, MD, MSc, Goodman Campbell Brain and Spine, Indiana University, Department of Neurosurgery, 355 W 16th St, No. 5100, Indianapolis, IN 46202. E-mail:

Received March 08, 2013

Accepted July 31, 2013

Copyright © by the Congress of Neurological Surgeons