Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Neurosurgery. 2013 Dec;73(6):933-9; discussion 939-40. doi: 10.1227/NEU.0000000000000131.
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.
To investigate the incidence and features of ischemia in treatment of AChA aneurysms.
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.
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.
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.
前脉络膜动脉（AChA）为神经系统的重要区域供血，特别是内囊后肢和视辐射。由于与 AChA 相对较小的直径相关的动脉瘤的复杂解剖结构，在夹闭或腔内线圈栓塞时保留母血管具有挑战性，因此治疗 AChA 动脉瘤具有特殊的挑战性。
探讨 AChA 动脉瘤治疗中缺血的发生率和特征。
通过查询 1985 年至 2011 年期间接受动脉瘤治疗的患者的前瞻性维护数据库，寻找 AChA 动脉瘤患者。使用未配对学生 t 检验和 Fisher 精确检验分析年龄、性别、Hunt 和 Hess 分级、治疗方式和并发症。
122 例患者共 127 个 AChA 动脉瘤，67%（82/122）有多个动脉瘤。治疗包括 112 例显微夹闭结扎术、8 例腔内线圈栓塞术、5 例动脉瘤包裹术和 2 例手术探查术。并发症发生在 53%（127 个中的 67 个）的 AChA 动脉瘤中。术后缺血发生在 12%（127 个中的 15 个）的治疗动脉瘤中。临时夹闭应用的次数与术后缺血最密切相关。出院时格拉斯哥预后量表评分 4 或 5 分的比例为 78%，6 个月时为 89%，1 年时为 85%。
AChA 动脉瘤手术治疗的缺血性并发症发生率与近端控制时临时夹闭应用的频率最密切相关，可能低于先前报道的水平。应使用术中辅助工具和限制血管操作来改善结果。
