2018 年 46 巻 3 号 p. 195-199
Direct surgery for internal carotid-anterior choroidal artery (IC-AChA) aneurysms has been considered difficult due to the complicated anatomy and fragile nature of the AChA. IC-AChA aneurysms are thought to have a higher risk of rupture regardless of size and patient age. In fact, our institution has experienced many ruptured IC-AChA aneurysms of relatively small size (< 5 mm), or in younger patients (<30 years old). We analyzed the clinical characteristics and outcomes in 111 patients who underwent direct surgery for IC-AChA aneurysms between 2001 and 2014. We had 1, 406 cases of direct surgery for unruptured cerebral aneurysms between 2001 and 2014, involving 434 male and 972 female patients, with average ages of 58.0 and 61.0, respectively. Of these, 111 were cases of IC-AChA aneurysm, involving 45 male and 56 female patients, with respective average ages of 59.2 and 57.4. In 85 cases (77%), the sizes of the IC-AChA aneurysms were less than 5 mm. We performed 99 neck clippings, including 7 cases of clipping on wrapping and 5 cases with wrapping. All direct surgeries were performed via trans-sylvian approaches in order to expose every branch of the AChA and to keep blood flow intact. Fortunately, we did not encounter any cerebral infarctions in the AChA perfusing region after any clipping operation, and had favorable outcomes in 108 cases (97.3%). Despite technical difficulty, our results demonstrated that surgery for IC-AChA aneurysms can be safely performed if painstaking approaches are used to avoid harming the blood flow in the anterior choroidal artery.