Efficacy analysis of microsurgical management of the anterior choroidal artery aneurysm: A report of 94 cases

Objective To explore the efficacy and safety of microsurgical treatment of choroidal artery aneurysm (AChAA). Methods A retrospective analysis was conducted on the clinical data of 94 patients with AChAA admitted to Department of Neurosurgery, Affiliated Hospital of Qingdao University from December 1997 to December 2018. Among them, 90 patients underwent aneurysm clipping with the Yasargil pterional approach, and 4 patients underwent modified pterional approach for decompressive craniectomy. After surgery, all patients were followed up clinically to assess the outcomes based on the Glasgow outcome scale(GOS) system. Results A total of 120 aneurysms were successfully clipped in 94 patients. Three patients developed cerebral hemorrhage after operation, including 1 case of epidural hematoma on the contralateral side of the lesion, 1 case of ipsilateral frontal lobe hematoma, and 1 case of contralateral basal ganglia hemorrhage. Seven patients developed cerebral infarction, including 1 case of large-scale cerebral infarction and 6 cases of basal ganglia infarction with paralysis. One case suffered from pulmonary embolism 3 days after operation. Three cases developed hydrocephalus and returned to independent life after ventriculoperitoneal shunting. The follow-up time in 94 patients was 6 to 120 months. Of the 94 patients, 84 (89.4%) were GOS Ⅳ, 3 (3.2%) were grade Ⅲ, 2 (2.1%) were grade Ⅱ, and 5 (5.3%) were grade Ⅰ. Conclusion Open microsurgical clipping remains important treatment for AChA aneurysms, for which sufficient understanding of microanatomy of the AchA combined with skilled microsurgical clipping techniques would help achieve satisfactory clinical outcomes. Key words: Intracranial aneurysm; Anterior choroidal artery; Neurosurgical procedures; Treatment outcome