scholarly journals Surgical Challenges Associated With Anterior Choroidal Artery Aneurysm Clipping: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E289-E289
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Region Of Interest ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Adjacent Structures ◽  
Clip Application ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract Surgical treatment of anterior choroidal artery (AChA) aneurysms is challenging because of the constrained operative corridor and limitations imparted by the surrounding rigid structures during the exposure. The AChA most commonly arises as a single branch from the communicating (C7) segment of the internal carotid artery but has 2 to 4 branches in approximately one-third of cases, and aneurysms generally arise from the parent vessel interface with these branches. This patient experienced a sentinel headache 4 d before presenting with subarachnoid hemorrhage. The patient had a large right AChA aneurysm with a unique configuration in which the parent vessel was located anterior to the aneurysm. Endovascular therapy was aborted because there was an AChA branch at the base of the aneurysm. An orbitozygomatic craniotomy was performed that provided transsylvian access to the region of interest. Clip application was challenging because of the close proximity of the branch vessels. Intraoperative indocyanine green evaluation and postoperative angiogram showed patency of the AChA and posterior communicating artery. This video demonstrates the surgical challenge associated with AChA aneurysms because of the proximity of adjacent structures and highlights the importance of meticulous technique during clip application. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Supraclinoid Internal Carotid Artery Aneurysm Clipping Complicated by Aneurysm Dome Origin of the Anterior Choroidal Artery: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (1) ◽  
pp. E41-E41
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Video Recording ◽  
Artery Aneurysm ◽  
High Morbidity ◽  
Anterior Choroidal Artery ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Supraclinoid Internal Carotid Artery

Abstract Supraclinoid internal carotid artery (ICA) aneurysms most commonly arise at the origin of the posterior communicating or anterior choroidal artery. The unique angioarchitecture presented in this case involved the anterior choroidal artery (AChA) originating from the dome of a supraclinoid ICA aneurysm. Treatment is associated with high morbidity because of the eloquent parenchyma perfused by the AChA. Therefore, the preservation of flow within the AChA during clipping is paramount. Anterior choroidal syndrome, comprising hemiplegia, hemianesthesia, and hemianopsia, conveys a significant morbidity. This syndrome is observed in the setting of AChA sacrifice and can be observed in a delayed manner after clipping. Anterior choroidal syndrome is of uncertain etiology but is associated with AChA infarction. This patient presented with tinnitus and was found to have an incidental supraclinoid ICA aneurysm with AChA originating from the aneurysmal dome. A right orbitozygomatic craniotomy was performed for a transsylvian approach to the aneurysm. A fenestrated clip was applied to occlude the aneurysmal portion of the ICA up to the point of AChA origin. A curved clip was then used to occlude the AChA segment of the aneurysm, providing patency to the AChA takeoff along the ICA. Patency of the AChA and ICA was confirmed with intraoperative angiography, and the patient had a favorable clinical outcome. This case exemplified an excellent surgical clipping of a challenging supraclinoid ICA aneurysm involving the need to preserve a vessel off the aneurysm dome. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Medium-Sized Incidental Anterior Choroidal Artery Aneurysm

2019 ◽  
pp. 79-86
Author(s):  
Jan-Karl Burkhardt ◽  
Michael T. Lawton
Keyword(s):  
Evoked Potentials ◽  
Intraoperative Monitoring ◽  
Motor Evoked Potentials ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Microsurgical Clipping ◽  
Aneurysm Occlusion ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract: Anterior choroidal artery (AChA) aneurysms are rare and can present a particular anatomical challenge in that they often incorporate the origin of the AChA. The success of aneurysm treatment in this location depends on completely occluding the aneurysm and preserving the AChA parent vessel to avoid a devastating AChA infarct, with deficits that can include hemiplegia and hemianopsia. This chapter presents the case of a female patient with an unruptured AChA aneurysm treated with microsurgical clipping. In addition to meticulous microsurgical technique based on anatomic knowledge, intraoperative monitoring including somatosensory evoked potentials, motor evoked potentials, and indocyanine green angiography is an important adjunct for a successful aneurysm occlusion without complications.

scholarly journals Disappearance of a ruptured distal anterior choroidal artery aneurysm following surgical revascularization for moyamoya disease with hemorrhagic onset

Nosotchu ◽  
2012 ◽  
Vol 34 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Keisuke Toyoda ◽  
Shuji fukuda ◽  
Shunsuke Ishizaka ◽  
Tomonori Takeshita ◽  
Kentaro Hayashi ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Surgical Revascularization ◽  
Anterior Choroidal ◽  
Choroidal Artery

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

2020 ◽  
Vol 81 (06) ◽  
pp. 501-507
Author(s):  
Chunli Lu ◽  
Yugong Feng ◽  
Huanting Li ◽  
Shifang Li ◽  
Lingwen Gu ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Artery Aneurysm ◽  
Postoperative Outcome ◽  
Anterior Choroidal Artery ◽  
Factors Influencing ◽  
Aneurysm Size ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract 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.

Distal anterior choroidal artery aneurysm associated with an arteriovenous malformation. intraoperative localization and treatment

2000 ◽  
Vol 53 (6) ◽  
pp. 546-551 ◽  
Author(s):  
Kiyoyuki Yanaka ◽  
Koji Tsuboi ◽  
Keishi Fujita ◽  
Kazuyasu Aoki ◽  
Sadayuki Takeuchi ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Anterior Choroidal ◽  
Intraoperative Localization ◽  
Choroidal Artery

Ruptured anomalous hyperplastic anterior choroidal artery aneurysm: a case report

2019 ◽  
pp. 1-2
Author(s):  
Takashi Mitsuhashi ◽  
Hidenori Oishi ◽  
Kohsuke Teranishi ◽  
Takuma Kodama ◽  
Kentaro Kudo ◽  
...  
Keyword(s):  
Case Report ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Anterior Choroidal ◽  
Choroidal Artery

scholarly journals Orbitozygomatic Craniotomy for Clipping a Complex Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E33-E33
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Video Recording ◽  
Artery Aneurysm ◽  
Sylvian Fissure ◽  
Parent Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Vessel Patency ◽  
Mca Aneurysm

Abstract Middle cerebral artery (MCA) aneurysms pose a surgical challenge because of the large caliber of the parent artery and the common need to dissect the sylvian fissure to permit access to the proximal and distal control. The neck of the aneurysm should be generously dissected to permit visualization of any adjacent lenticulostriate perforators. This patient demonstrated a left-sided wide-necked bilobed MCA aneurysm at the M1 bifurcation. The aneurysm was approached using a left orbitozygomatic craniotomy with distal sylvian fissure dissection. A single curved clip was applied for aneurysm occlusion, and postoperative angiography demonstrated aneurysm obliteration with parent vessel patency. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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