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Multiple anterior choroidal arteries and perioperative ischemic complications in unruptured anterior choroidal artery aneurysms treated with microsurgical clipping

  • Review Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

This study aimed to identify the association between the number of anterior choroidal arteries (AchoAs) and procedure-related ischemic complications in microsurgical clipping of unruptured AchoA aneurysms.

Methods

We retrospectively reviewed the clinical, radiological, and intraoperative findings of 153 patients with unruptured AchoA aneurysms treated with microsurgical clipping between January 2012 and November 2020 in a single tertiary institution. Intraoperative video clips were reviewed, and the AchoA type was categorized into two according to the number of AchoAs: (1) single-type group with single origin and single branch and (2) multiple-type group with duplicated origin or divided multiple branches. Uni- and multivariate analyses were performed to assess the relationship between clinical and radiological factors and perioperative ischemic complications.

Results

Of the 153 patients, 52 (34%) were categorized as multiple-type group. The frequency of perioperative ischemic complications, including decreased intraoperative motor evoked potential (MEP), silent infarction, and postoperative ischemic symptoms, was significantly higher in the multiple-type group than in the single-type group (13 [25%] vs 6 [5.9%], p = 0.001). Multivariate logistic regression analysis showed that multiple-type group (odds ratio [OR], 3.725; 95% confidence interval [CI], 1.171–11.845, p = 0.026) and multilobulated shape (OR, 9.512; 95% CI, 2.093–43.224; p = 0.004) were significantly associated with perioperative ischemic complications. Among 9 patients with decreased MEP, postoperative ischemic symptoms developed in 2 patients after clip adjustment.

Conclusions

Multiple-type AchoA aneurysms and multilobulated shape are significantly correlated with perioperative ischemic complications. Postoperative ischemic complications can be minimized by recognizing these variations and using multimodal approach with MEP monitoring.

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Authors and Affiliations

  1. Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seocho-gu, Seoul, 06591, Republic of Korea

    Jung Koo Lee, Jai Ho Choi & Yong Sam Shin

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  1. Jung Koo Lee
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  2. Jai Ho Choi
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Corresponding author

Correspondence to Jai Ho Choi.

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This study was approved by the appropriate ethics committee and was therefore performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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For this study design, informed consent is not required.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Lee, J.K., Choi, J.H. & Shin, Y.S. Multiple anterior choroidal arteries and perioperative ischemic complications in unruptured anterior choroidal artery aneurysms treated with microsurgical clipping. Acta Neurochir 163, 2947–2953 (2021). https://doi.org/10.1007/s00701-021-04901-4

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  • DOI: https://doi.org/10.1007/s00701-021-04901-4

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