Prof. Martin SAMESCzech Republic
Department of Neurosurgery, Masaryk Hospital, University J.E.Purkyne, Usti nad Labem, Czech Republic
1997 to present | Head Of Department of Neurosurgery |
2012 to present | Professor and Chaiman |
Neurosurgery, Skull base surgery, Vascular neurosrgery
Management of anterior choroidal artery aneurysms
1109 08:15-08:25
AASNS & WANS Joint Seminar/305
Management of anterior choroidal artery aneurysms
Sames M., Zítek H., Hejčl A., Vachata P., Bartoš R., Cihlář F.
Department of Neurosuegery, Masaryk Hospital, University J.E.Purkinje, Usti nad Labem,
Czech Republic
Introduction:
Anterior choroidal artery (AChoA) aneurysms belong to less frequent cerebrovascular lesions (2-5% of all intracranial aneurysms) and therefore there are still only a few reports describing neurosurgical management. The aim of this presentation is 1) to emphasize the complexity of surgical clipping of aneurysms in anatomically complicated area of AchoA when important perforators arise in close proximity or directly from the aneurysm. 2) to analyze indications and outcomes of both surgical and endovascular treatment (flow-diversion) in review of recent literature.
Material and Results:
Authors present four cases of incidental large AChoA aneurysms using clipping with suction decompression technique. The patients had an uneventful postoperative course. The postoperative CT angiography did not show any sign of complication or sac residue.
Conclusion:
Surgical clipping, supported with combination of monitoring methods (TCD, ICG, MEP) is a safe method and a better alternative to endovascular treatment when choroidal artery arising from the neck of aneurysm. Occlusion rate of AChoA after flow-diversion treatment is 3,5% - 7% (2,3,4).
References:
1. Aoki T, Hirohata M, Noguchi K, Komaki S, Orito K, Morioka M. Comparative outcome analysis of anterior choroidal artery aneurysms treated with endovascular coiling or surgical clipping. Surg Neurol Int. 2016;7(Suppl 18): S504-509.
2. Brinjikji W, Kallmes DF, Cloft HJ, Lanzino G. Patency of the anterior choroidal artery after flow-diversion treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol. 2015 Mar;36(3):537–41.
3. Raz E, Shapiro M, Becske T, Zumofen DW, Tanweer O, Potts MB, et al. Anterior choroidal artery patency and clinical follow-up after coverage with the pipeline embolization device. AJNR Am J Neuroradiol. 2015 May;36(5):937–42.
4. Guédon A et al. Very late ischemic complications in flow-diverter stents: a retrospective analysis of a single-center series. J Neurosurg. 2016 Oct;125(4):929-935
1. Sub-temporal approach for large SCA aneurysm
2. Large C2 aneurysm with inferior direction of fundus clipping with prophylactic EC-IC bypass
3. Cervico-medullary tumor resected via posteromedian sulcus (safe entry zone)
1109 15:15-15:25
Video Session/304B