Background: Surgical clipping of the internal carotid artery–anterior choroidal artery aneurysm (ICA–AchA AN) has some risk of ischemic complications. One reason for this is the multiplicity of the AchA branches. We report our experience with the surgical clipping of the ICA–AchA ANs.
Methods: We treated 36 cases of ICA–AchA AN between May 2007 and April 2012, and classified them based on the origin of the AchA by intraoperative investigation. We used two techniques for clipping the ICA–AchA AN. The rotation technique was used to observe the origin of the AchA behind the aneurysm, and the blading technique was used to visualize the neck of the aneurysm by tipping the clip blade back and forth. Clipping was performed with motor evoked potential (MEP) monitoring in 13 cases of unruptured aneurysms, indocyanine green (ICG) videoangiography in 27 cases, and doppler sonography in all cases.
Results: There were no postoperative ischemic complications. The origins of the AchA were at the proximal neck in 29 cases (80.6%), at the proximal and distal necks in three cases (8.3%), and in a direct branch from the aneurysmal dome in four cases (11.1%). Not all branches were visible on preoperative CT angiography and 3D-rotational angiography. We applied clips carefully to preserve any AchA branch, and no changes in MEP waves were observed. In one case, we repositioned the clips because the ICG videoangiography findings were inconclusive. Postoperative courses were uneventful in all patients, except for seizure in two and transient oculomotor palsy in two.
Conclusion: To avoid ischemic complications after clipping of the ICA–AchA ANs, microscopic visualization of the origin and the direction of the AchA is very important. Moreover, using Doppler sonography, ICG videoangiography and MEP monitoring can produce good surgical results.
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