Microneurosurgical Management of Anterior Choroid Artery Aneurysms

被引：34

作者：

Lehecka, Martin ^{[1
]}

Dashti, Reza ^{[1
]}

Laakso, Aki ^{[1
]}

van Popta, Jouke S. ^{[1
]}

Romani, Rossana ^{[1
]}

Navratil, Ondrej ^{[1
]}

Kivipelto, Leena ^{[1
]}

Kivisaari, Riku ^{[1
]}

Foroughi, Mansoor ^{[1
]}

Kokuzawa, Jouji ^{[1
]}

Lehto, Hanna ^{[1
]}

Niemela, Mika ^{[1
]}

Rinne, Jaakko ^{[2
]}

Ronkainen, Antti ^{[2
]}

Koivisto, Timo ^{[2
]}

Jaaskelainen, Juha E. ^{[2
]}

Hernesniemi, Juha ^{[1
]}

机构：

[1] Univ Helsinki, Cent Hosp, Dept Neurosurg, FIN-00014 Helsinki, Finland

[2] Kuopio Univ Hosp, Dept Neurosurg, Kuopio, Finland

来源：

WORLD NEUROSURGERY | 2010年 / 73卷 / 05期

关键词：

Aneurysm; Anterior choroid artery; Clipping; Internal carotid artery; Microanatomy; Microsurgical technique; Subarachnoid hemorrhage; MIDDLE CEREBRAL-ARTERY; INTERNAL CAROTID-ARTERY; COMPUTERIZED-TOMOGRAPHY ANGIOGRAPHY; INDOCYANINE GREEN VIDEOANGIOGRAPHY; POSTERIOR COMMUNICATING ARTERY; MICROSURGICAL ANATOMY; INTRACRANIAL ANEURYSMS; CT ANGIOGRAPHY; SUBARACHNOID HEMORRHAGE; PERFORATING BRANCHES;

D O I：

10.1016/j.wneu.2010.02.001

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

OBJECTIVE: Anterior choroid artery aneurysms (AChAAs) constitute 2%-5% of all intracranial aneurysms. They are usually small, thin walled with one or several arteries originating at their base, and often associated with multiple aneurysms. In this article, we review the practical microsurgical anatomy, the preoperative imaging, surgical planning, and the microneurosurgical steps in the dissection and the clipping of AChAAs. METHODS: This review, and the whole series on intracranial aneurysms (IAs), are mainly based on the personal microneurosurgical experience of the senior author (J.H.) in two Finnish centers (Helsinki and Kuopio) that serve, without patient selection, the catchment area in Southern and Eastern Finland. RESULTS: These two centers have treated more than 10,000 patients with IAs since 1951. In the Kuopio Cerebral Aneurysm Database of 3005 patients with 4253 IAs, 831 patients (28%) had altogether 980 internal carotid artery (ICA) aneurysms, of whom 95 patients had 99 (2%) AChAAs. Ruptured AChAAs, found in 39 patients (41%), with median size of 6 mm (range = 2-19 mm), were associated with intracerebral hematoma (ICH) in only 1 (3%) patient. Multiple aneurysms were seen in 58 (61%) patients. CONCLUSIONS: The main difficulty in microneurosurgical management of AChAAs is to preserve flow in the anterior choroid artery originating at the base and often attached to the aneurysm dome. This necessitates perfect surgical strategy based on preoperative knowledge of 3 dimensional angioarchitecture and proper orientation during the microsurgical dissection.

引用

页码：486 / 499

页数：14

共 72 条

[41]

MORELLO A, 1955, AMER J ROENTGENOL RA, V73, P748

[42] Water dissection technique of Toth for opening neurosurgical cleavage planes [J].