Neurological Complications and Surgical Outcome in Patients with Anterior Choroidal Segment Aneurysms

ABSTRACT

Introduction: Choroidal segment aneurysms occur in close relation to terminal internal carotid branches and concomitant anatomical variations in the anterior choroidal artery. The authors evaluate the demographics, presentation, operative techniques, and surgical outcome in 13 patients with this aneurysm. Methods: After identifying the study group from a retrospective review of all supraclinoid ICA aneurysms operated in our institution over an 8-year period, analysis was done with respect to the radiological and operative findings and clinical follow-up. Statistical significance for outcome was analyzed using two-tailed Fisher's exact test (p < 0.05). Results: The incidence of choroidal segment aneurysm was 3.02%. Six (46%) patients had Fisher grade III bleed on imaging. Nine (69%) patients had a good surgical outcome. Three patients had ischemic stroke in the anterior choroidal territory. Patient demographics, Hunt and Hess score at presentation, Fisher score on computed tomogram scan, aneurysm characteristics and clip configuration had no bearing on surgical outcome. Conclusions: In patients with anterior choroidal artery aneurysms managed surgically, meticulous surgical exposure, identification of anatomical variations of parent artery, appropriate clip selection and usage of intra-operative Doppler limit ischemic complications, and allay the development of the morbid clinical syndrome associated with anterior choroidal territory infarction.

KEYWORDS: :

• aneurysm
• anterior choroidal artery
• hemiplegia
• infarction
• sub-arachnoid hemorrhage
• surgery