Department of Neurosurgery, Helsinki University Central Hospital, Finland.
World Neurosurg. 2010 May;73(5):486-99. doi: 10.1016/j.wneu.2010.02.001.
Anterior choroid artery aneurysms (AChAAs) constitute 2%-5% of all intracranial aneurysms. They are usually small, thin walled with one or several arteries originating at their base, and often associated with multiple aneurysms. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of AChAAs.
This review, and the whole series on intracranial aneurysms (IAs), are mainly based on the personal microneurosurgical experience of the senior author (J.H.) in two Finnish centers (Helsinki and Kuopio) that serve, without patient selection, the catchment area in Southern and Eastern Finland.
These two centers have treated more than 10,000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 IAs, 831 patients (28%) had altogether 980 internal carotid artery (ICA) aneurysms, of whom 95 patients had 99 (2%) AChAAs. Ruptured AChAAs, found in 39 patients (41%), with median size of 6 mm (range = 2-19 mm), were associated with intracerebral hematoma (ICH) in only 1 (3%) patient. Multiple aneurysms were seen in 58 (61%) patients.
The main difficulty in microneurosurgical management of AChAAs is to preserve flow in the anterior choroid artery originating at the base and often attached to the aneurysm dome. This necessitates perfect surgical strategy based on preoperative knowledge of 3 dimensional angioarchitecture and proper orientation during the microsurgical dissection.
前交通动脉动脉瘤（AChAAs）占所有颅内动脉瘤的 2%-5%。它们通常较小，壁薄，有一条或多条动脉发自其基底，常与多个动脉瘤相关。本文回顾了 AChAAs 的实用显微解剖学、术前影像学、手术规划以及在分离和夹闭过程中的显微神经外科步骤。
本综述以及颅内动脉瘤（IAs）的整个系列主要基于资深作者（J.H.）在两个芬兰中心（赫尔辛基和库奥皮奥）的个人显微神经外科经验，这两个中心为芬兰南部和东部地区提供服务，没有患者选择。
这两个中心自 1951 年以来已经治疗了超过 10000 例 IAs 患者。在库奥皮奥脑动脉瘤数据库中，3005 例患者中有 4253 个 IAs，831 例患者共有 980 个颈内动脉（ICA）动脉瘤，其中 95 例患者有 99 个（2%）AChAAs。破裂的 AChAAs 见于 39 例患者（41%），中位大小为 6mm（范围=2-19mm），仅 1 例（3%）患者伴有脑内血肿（ICH）。58 例（61%）患者存在多发动脉瘤。
AChAAs 显微神经外科治疗的主要困难是保留发自基底、常附着于动脉瘤瘤顶的前交通动脉的血流。这需要基于术前三维血管造影结构的了解和在显微神经外科分离过程中的正确定向来制定完美的手术策略。
