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Aneuryzma arteria choroidea anterior


Autoři: H. Zítek 1;  A. Hejčl 1,2;  F. Cihlář 3;  A. Sejkorová 1;  M. Sameš 1
Působiště autorů: Neurochirurgická klinika Fakulty zdravotnických studií UJEP a Masarykovy nemocnice v Ústí nad Labem 1;  Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 2;  Radiologická klinika UJEP a Masarykovy nemocnice v Ústí nad Labem 3
Vyšlo v časopise: Cesk Slov Neurol N 2019; 82(3): 350-351
Kategorie: Dopisy redakci
doi: https://doi.org/10.14735/amcsnn2019350

Souhrn

Aim: Anterior choroidal artery aneurysms (AChoAA) belong to less frequent cerebrovascular lesions and therefore there are still only a few reports describing their neurosurgical management. We decided to share our experience and present two unusual cases of AChoAA we have treated in our department. We also report one of the first published use of the Yasargil T-bar fenestrated clip for solving of a AChoAA.

Methods: We present two cases of unruptured AChoAA treated in 2016 with respect to patient's history, radiological and microsurgical anatomy of the aneurysm, surgical procedure and clinical follow-up. Results: Both aneurysms were successfully treated with surgical clipping. In case 1 we used a single T-bar fenestrated clip. To our best knowledge this might be the first reported use of such clip in treatment of AChoAA. In case 2 for a large AChoAA a standard straight Aesculap clip was used. Both procedures were performed with microvascular Doppler sonography and under electrophysiological monitoring with motor-evoked potentials (MEP). Temporary disturbance in MEP signal during surgery was observed in the T-bar clip case and led to reposition of the clip. Both patients had a good surgical outcome without any clinical or radiological signs of ischemia in the AChoA or any other territory.

Conclusion: As previous literature we confirm that surgical treatment of AChoAA is a good and safe alternative to endovascular treatment. We propose, using T-bar fenestrated clip might be appropriate solution for treatment of these lesions. We also suggest that combination of monitoring methods (MVDS, ICG and MEP monitoring) during AChoAA surgery is a very valuable way for prevention of ischemic infarction in the AChoA territory.

Klíčová slova:

anterior choroidal artery aneurysm – surgical clipping – endovascular treatment – T-bar clip – intraoperative monitoring techniques


Zdroje

1. Friedman JA, Pichelmann MA, Piepgras DG et al. Ischemic complications of surgery for anterior choroidal artery aneurysms. J Neurosurg 2001; 94(4): 565–572. doi: 10.3171/jns.2001.94.4.0565.

2. Furtado SV, Venkatesh PK, Hegde AS. Neurological complications and surgical outcome in patients with anterior choroidal segment aneurysms. Int J Neurosci 2010; 120(4): 291–297. doi: 10.3109/00207451003668390.

3. Kim BM, Kim DI, Shin YS et al. Clinical outcome and ischemic complication after treatment of anterior choroidal artery aneurysm: comparison between surgical clipping and endovascular coiling. AJNR Am J Neuroradiol 2008; 29(2): 286–290. doi: 10.3174/ajnr.A0806.

4. Lee YS, Park J. Anterior choroidal artery aneurysm surgery: ischemic complications and clinical outcomes revisited. J Korean Neurosurg Soc 2013; 54(2): 86–92. doi: 10.3340/jkns.2013.54.2.86.

5. Lehecka M, Dashti R, Laakso A et al. Microneurosurgical management of anterior choroid artery aneurysms. World Neurosurg 2010; 73(5): 486–499. doi: 10.1016/j.wneu.2010.02.001.

6. Li J, Mukherjee R, Lan Z et al. Microneurosurgical management of anterior choroidal artery aneurysms: a 16–year institutional experience of 102 patients. Neurol Res 2012; 34(3): 272–280. doi: 10.1179/1743132812Y.0000000008.

7. Piotin M, Mounayer C, Spelle L et al. Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol 2004; 25(2): 314–318.

8. Senturk C, Bandeira A, Bruneau M et al. Endovascular treatment of anterior choroidal artery aneurysms. J Neuroradiol 2009; 36(4): 228–232. doi: 10.1016/j.neurad.2008.12.002.

9. Marinković S, Gibo H, Brigante L et al. The surgical anatomy of the perforating branches of the anterior choroidal artery. Surg Neurol 1999; 52(1): 30–36.

10. Yasargil MG (ed.). Microneurosurgery. Vol. I. New York.: Georg Thieme Verlag 1984.

11. Yasargil MG (ed.). Microneurosurgery. Vol II. New York.: Georg Thieme Verlag 1984.

12. Foix Ch, Chavany JA, Hillemand P. Oblitération de l’artere choroidienne antérieure. Ramollissement cérébral, hémiplégie, hémianesthésie et hémianopsie. Soc Ophtalmol 1925: 221–223.

13. Palomeras E, Fossas P, Cano AT et al. Anterior choroidal artery infarction: a clinical, etiologic and prognostic study. Acta Neurol Scand 2008; 118(1): 42–47. doi: 10.1111/j.1600–0404.2007.00980.x.

14. Bohnstedt BN, Kemp WJ, Li Y et al. Surgical treatment of 127 anterior choroidal artery aneurysms: a cohort study of resultant ischemic complications. Neurosurgery 2013; 73(6): 933–940. doi: 10.1227/NEU.0000000000000131.

15. Hernesniemi J, Ishii K, Niemelä M et al. Lateral supraorbital approach as an alternative to the classical pterional approach. Acta Neurochir 2005; 94 (Suppl): 17–21.

16. Hejčl A, Radovnický T, Sameš M. Our experience with lateral supraorbital approach in surgery of intracranial aneurysms. Cesk Slov Neurol N 2012; 75/108(2): 203–207.

17. Sakuma J, Suzuki K, Sasaki T et al. Monitoring and preventing blood flow insufficiency due to clip rotation after the treatment of internal carotid artery aneurysms. J Neurosurg 2004; 100(5): 960–962. doi: 10.3171/jns.2004.100.5.0960.

18. Shibata Y, Fujita S, Kawaguchi T et al. Use of microvascular Doppler sonography in aneurysm surgery on the anterior choroidal artery. Neurol Med Chir (Tokyo) 2000; 40(1): 30–37. doi: 10.2176/nmc.40.30.

19. Neuloh G, Schramm J. Monitoring of motor evoked potentials compared with somatosensory evoked potentials and microvascular Doppler ultrasonography in cerebral aneurysm surgery. J Neurosurg 2004; 100(3): 389–399. doi: 10.3171/jns.2004.100.3.03893.

20. Suzuki K, Kodama N, Sasaki T et al. Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery. J Neurosurg 2003; 98(3): 507–514. doi: 10.3171/jns.2003.98.3.0507.

21. Dashti R, Laakso A, Niemelä M et al. Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience. Surg Neurol 2009; 71(5): 543–550. doi: 10.1016/j.surneu.2009.01.027.

22. de Oliveira JG, Beck J, Seifert V et al. Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery 2008; 62 (6 Suppl 3): 1300–1310. doi: 10.1227/01.neu.0000333795.21468.d4.

23. Raabe A, Beck J, Seifert V. Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. Zentralbl Neurochir 2005; 66(1): 1–8. doi: 10.1055/s–2004–836223.

24. Drake CG, Vanderlinden RG, Amacher AL. Carotid–choroidal aneurysms. J Neurosurg 1968; 29(1): 32–36. doi: 10.3171/jns.1968.29.1.0032.

25. Viale GL, Pau A. Carotid–choroidal aneurysms: remarks on surgical treatment and outcome. Surg Neurol 1979; 11(2): 141–145.

26. Yasargil MG, Yonas H, Gasser JC. Anterior choroidal artery aneurysms: their anatomy and surgical significance. Surg Neurol 1978; 9(2): 129–138.

27. Cho MS, Kim MS, Chang CH et al. Analysis of clip–induced ischemic complication of anterior choroidal artery aneurysms. J Korean Neurosurg Soc 2008; 43(3): 131–134. doi: 10.3340/jkns.2008.43.3.131.

28. Aoki T, Hirohata M, Noguchi K et al. Comparative outcome analysis of anterior choroidal artery aneurysms treated with endovascular coiling or surgical clipping. Surg Neurol Int 2016; 7 (Suppl 18): 504–509. doi: 10.4103/2152–7806.187492.

29. Kim BM, Kim DI, Chung EC et al. Endovascular coil embolization for anterior choroidal artery aneurysms. Neuroradiology 2008; 50(3): 251–257. doi: 10.1007/s00234–007–0331–0.

30. Kang HS, Kwon BJ, Kwon OK et al. Endovascular coil embolization of anterior choroidal artery aneurysms. Clinical article. J Neurosurg 2009; 111(5): 963–969. doi: 10.3171/2009.4.JNS08934.

31. Brinjikji W, Kallmes DF, Cloft HJ et al. Patency of the anterior choroidal artery after flow–diversion treatment of internal carotid artery aneurysms. AJNR Am J Neuroradiol 2015; 36(3): 537–541. doi: 10.3174/ajnr.A4139.

32. Neki H, Caroff J, Jittapiromsak P et al. Patency of the anterior choroidal artery covered with a flow–diverter stent. J Neurosurg 2015; 123(6): 1540–1545. doi: 10.3171/2014.11.JNS141603.

33. Raz E, Shapiro M, Becske T et al. Anterior choroidal artery patency and clinical follow-up after coverage with the pipeline embolization device. AJNR Am J Neuroradiol 2015; 36(5): 937–942. doi: 10.3174/ajnr.A4217.

34. Başkaya MK, Uluç K. Application of a new fenestrated clip (Yaşargil T–bar clip) for the treatment of fusiform M1 aneurysm: case illustration and technical report. Neurosurgery 2012; 70 (Suppl 2): 339–342. doi: 10.1227/NEU.0b013e3182330ef7.

35. Zada G, Christian E, Liu CY et al. Fenestrated aneurysm clips in the surgical management of anterior communicating artery aneurysms: operative techniques and strategy. Clinical article. Neurosurg Focus 2009; 26(5): E7. doi: 10.3171/2009.2.FOCUS08314.

Štítky
Dětská neurologie Neurochirurgie Neurologie
Článek Editorial

Článek vyšel v časopise

Česká a slovenská neurologie a neurochirurgie

Číslo 3

2019 Číslo 3

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