Anterior Choroidal Artery Aneurysms: Clinical Characteristics and Surgical Outcome

Surgical treatment of anterior choroidal artery (AChA) aneurysms used to be associated with a high risk of ischemic stroke in the AChA territory. We retrospectively studied 70 consecutive patients with AChA aneurysms to evaluate their clinical characteristics and surgical outcome against the background of routine use of indocyanine green video angiography and motor-evoked potential (MEP). Between 2007 and 2016, 70 procedures were performed for 70 patients with AChA aneurysms. AChA aneurysms were the primary target in 45 patients and the secondary target in 25 patients. Nineteen patients were men and 51 were women, with a mean age of 60.1 years. The mean size of the aneurysm was 4.2 mm. Sixty-eight aneurysms were obliterated with clips. Combination of multiple clips was required in 18 aneurysms to secure the patency of the origin of AChA. Decreased MEP amplitude was observed in 8 of 68 procedures with MEP monitoring but fully recovered after readjustment of the clips. None of the 49 patients without subarachnoid hemorrhage (SAH) and 12 patients with SAH grades 1 and 2 according to the World Federation of Neurological Surgeons classification developed symptomatic ischemia of AChA. Postoperative diffusion-weighted imaging revealed high intensity in the AChA territory in one patient, but the lesion was asymptomatic. Provided that sufficient operative field is obtained to allow inspection of the aneurysm in multiple angles and careful angioplastic clipping technique is utilized under appropriate monitoring, surgical clipping of the AChA aneurysm is associated with low risk of ischemic complications.