Application of multiple auxiliary techniques in microsurgical clipping of anterior choroidal artery aneurysms
Zeng Yongqin
Shi Tao
Liu Da
Zhang Xubiao
Chen Zhijie
Guo Dongliang
Deng Bin
Wang Dong
Wang Guoliang
Lin Tao
Abstract：Objective To investigate the application of multiple auxiliary techniques in microsurgical clipping of anterior choroidal artery(AChA)aneurysms,aiming to improve the success rate of AChA aneurysm clipping,reduce aneurysm neck remnants,and decrease the incidence of ischemic stroke.Methods The clinical data of 18 patients with AChA aneurysms were analyzed retrospectively.Among them,14 patients presented with preoperative subarachnoid hemorrhage(SAH).All the patients underwent craniotomy and microsurgical clipping(accounting for approximately 4.4%of all aneurysms clipped surgically during the same period).Preoperatively,all the patients underwent computed tomography angiography(CTA)and three-dimensional digital subtraction angiography(3D-DSA)to comprehensively assess aneurysm size,morphology,orientation,neck width,relationships with the parent artery,surrounding branch vessels,and bony structures(anterior clinoid process),guiding intraoperative head positioning and clip placement angles.Additionally,intraoperative electrophysiological monitoring of somatosensory evoked potentials(SEP)and motor-evoked potentials(MEP),transcranial Doppler(TCD)monitoring of the patency of the parent artery and its branches,and indocyanine green(ICG)videoangiography to visualize aneurysm filling and vascular perfusion were employed.Based on complete aneurysm neck occlusion,postoperative aneurysm remnants and ischemic stroke occurrences were analyzed.Results Successful and precise clipping of AChA aneurysms was achieved in 17 cases,with only 1 case showing neck remnants and 2 cases of cerebral infarction.Follow-up ranged from 10 to 20 months,during which no rebleeding or recurrence of aneurysms occurred.Modified Rankin Scale(mRS)score was as follows:0 in 5 cases,1 in 7,2 in 4,3 and 4 in 1 case respectively,with no deaths.Conclusions Preoperative proficient use of CTA and 3D-DSA reconstruction techniques to thoroughly understand the three-dimensional structure and specific morphology of AChA aneurysms enables accurate assessment of the difficulty of clipping.Intraoperative electrophysiological monitoring,TCD,and ICG videoangiography can clarify the presence of aneurysm remnants,parent artery patency,or occlusion of perforating arteries after clipping,guiding adjustments to the aneurysm clip for optimal occlusion.This comprehensive approach can reduce the incidence of aneurysm neck remnants and ischemic stroke.
Keywords：intracranial aneurysmanterior choroidal arterymultiple auxiliary methodsmicrosurgery
Publication Date：2024-07-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 414-419 )