J Neurol Surg A Cent Eur Neurosurg 2020; 81(06): 501-507
DOI: 10.1055/s-0039-3400952
Original Article

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

Chunli Lu
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Yugong Feng
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Huanting Li
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Shifang Li
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Lingwen Gu
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Wei Liu
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Pining Zhang
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Hongliang Zhang
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
,
Donglin Lu
1   Department of Neurosurgery, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, People’s Republic of China
› Author Affiliations

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.



Publication History

Received: 06 April 2019

Accepted: 03 July 2019

Article published online:
19 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Rhoton Jr AL, Fujii K, Fradd B. Microsurgical anatomy of the anterior choroidal artery. Surg Neurol 1979; 12 (02) 171-187
  • 2 Lehecka M, Dashti R, Laakso A. et al. Microneurosurgical management of anterior choroid artery aneurysms. World Neurosurg 2010; 73 (05) 486-499
  • 3 Hupperts RM, Lodder J, Heuts-van Raak EP, Kessels F. Infarcts in the anterior choroidal artery territory. Anatomical distribution, clinical syndromes, presumed pathogenesis and early outcome. Brain 1994; 117 (Pt 4): 825-834
  • 4 Friedman JA, Pichelmann MA, Piepgras DG. et al. Ischemic complications of surgery for anterior choroidal artery aneurysms. J Neurosurg 2001; 94 (04) 565-572
  • 5 Palomeras E, Fossas P, Cano AT, Sanz P, Floriach M. Anterior choroidal artery infarction: a clinical, etiologic and prognostic study. Acta Neurol Scand 2008; 118 (01) 42-47
  • 6 Furtado SV, Venkatesh PK, Hegde AS. Neurological complications and surgical outcome in patients with anterior choroidal segment aneurysms. Int J Neurosci 2010; 120 (04) 291-297
  • 7 Drake CG, Vanderlinden RG, Amacher AL. Carotid-choroidal aneurysms. J Neurosurg 1968; 29 (01) 32-36
  • 8 Yasargil MG, Yonas H, Gasser JC. Anterior choroidal artery aneurysms: their anatomy and surgical significance. Surg Neurol 1978; 9 (02) 129-138
  • 9 Marinković S, Gibo H, Brigante L, Nikodijević I, Petrović P. The surgical anatomy of the perforating branches of the anterior choroidal artery. Surg Neurol 1999; 52 (01) 30-36
  • 10 Tanriover N, Kucukyuruk B, Ulu MO. et al. Microsurgical anatomy of the cisternal anterior choroidal artery with special emphasis on the preoptic and postoptic subdivisions. J Neurosurg 2014; 120 (05) 1217-1228
  • 11 Uz A, Erbil K, Esmer A. The origin and relations of the anterior choroidal artery: an anatomical study. Folia Morphol (Warsz) 2005; 64 (04) 269-272
  • 12 Lee YS, Park J. Anterior choroidal artery aneurysm surgery: ischemic complications and clinical outcomes revisited. J Korean Neurosurg Soc 2013; 54 (02) 86-92
  • 13 Saeki N, Rhoton Jr AL. Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis. J Neurosurg 1977; 46 (05) 563-578
  • 14 Viale GL, Pau A. Carotid-choroidal aneurysms: remarks on surgical treatment and outcome. Surg Neurol 1979; 11 (02) 141-145
  • 15 Li J, Mukherjee R, Lan Z, Liu Y, He M. Microneurosurgical management of anterior choroidal artery aneurysms: a 16-year institutional experience of 102 patients. Neurol Res 2012; 34 (03) 272-280
  • 16 Bohnstedt BN, Kemp III WJ, Li Y. et al. Surgical treatment of 127 anterior choroidal artery aneurysms: a cohort study of resultant ischemic complications. Neurosurgery 2013; 73 (06) 933-939 ; discussion 939–940
  • 17 Jang CK, Park KY, Lee JW. et al. Microsurgical treatment of unruptured anterior choroidal artery aneurysms: incidence of and risk factors for procedure-related complications. World Neurosurg 2018; 119: e679-e685
  • 18 André A, Boch AL, Di Maria F. et al. Complication risk factors in anterior choroidal artery aneurysm treatment. Clin Neuroradiol 2018; 28 (03) 345-356
  • 19 Szelényi A, Langer D, Kothbauer K, De Camargo AB, Flamm ES, Deletis V. Monitoring of muscle motor evoked potentials during cerebral aneurysm surgery: intraoperative changes and postoperative outcome. J Neurosurg 2006; 105 (05) 675-681