2025 Volume 53 Issue 2 Pages 82-87
Anterior choroidal artery (AchA) aneurysms clipping carries a high risk of ischemic complications due to several factors: the small diameter of the AchA, cases in which the AchA branches off from the aneurysm wall, and frequent adhesion of the AchA to the dorsal wall of the aneurysm. To reduce the risk of clipping the AchA aneurysm and subsequently decrease blood flow to the AchA, we intentionally left a small remnant of the aneurysm during the clipping procedure to preserve blood flow. The remaining aneurysmal wall was then coated with a small number of Bemsheets and fibrin glue. We retrospectively investigated the treatment outcomes and long-term outcomes of this surgical strategy. Between 2007 and 2018, we performed direct surgery on 63 patients with AchA aneurysms, enrolling 25 patients (mean age, 60 years; 76% females) in whom coating was applied to the residual aneurysm wall after clipping. These patients could perform daily activities independently postoperatively. The aneurysm sizes ranged from 2 to 7 mm (mean, 4 mm), with 18 unruptured aneurysms. Parallel clipping was performed in 88% of the patients. There were no cases of ischemic complications associated with this surgical technique. During the average follow-up period of 7.6 years, we observed no cases of ischemia in the AchA region, recurrence, or bleeding from residual aneurysms. In conclusion, clipping an AchA aneurysm while intentionally leaving a small remnant of the neck to preserve the AchA blood flow is a safe technique with significant therapeutic benefits. Additionally, coating the aneurysm remnant with a small amount of Bemsheets and fibrin glue may prevent recurrence and bleeding.
