Microneurosurgical management of anterior choroidal artery aneurysms: a 16-year institutional experience of 102 patients

Abstract

Objective: Surgical treatment of anterior choroidal artery aneurysms (AChAAs) continues to be challenging and technically demanding for vascular neurosurgeons. Ischemic stroke is the most common complication after surgical clipping of AChAAs. We retrospectively studied a series of 102 consecutive patients with AChAAs to evaluate the clinical outcomes and ischemic complications after surgical clipping.Methods: Between January 1995 and December 2010, 102 patients presenting at West China Hospital, with a total of 106 AChAAs that were treated with surgical clipping were included in this study. There were 40 men (39%) and 62 women (61%) with an average age of 52 years (range 34–78 years). There were 62 small, 40 medium, and 4 large aneurysms. Clinical outcomes, treatment-related complications, follow-up results, and the factors influencing the clinical outcomes were evaluated.Results: Eighty-three patients (81%) achieved a good outcome (Glasgow outcome scale score 4–5) at follow-up for a mean of 18·8 months (range 4–103 months). The surgical mortality rate was 7%, and the major surgical morbidity was 12%. Fifteen patients (15%) had clinical anterior choroidal artery (AChA) territory infarction confirmed by computerized tomography. In 36 patients, the AChAA was originated entirely or partially from the AChA itself, 10 (27·8%) of them had postoperative ischemic complication. None of the 95 followed patients had rebleeding or regrowth of residual aneurysm during this period.Conclusions: The surgery of AChAAs is not easy, surgical management of AChAAs carries with it a high risk of postoperative ischemic complications, especially for those aneurysms originating entirely or partially from the AChA itself.