دورية أكاديمية
Microsurgical Clipping of Anterior Choroidal Artery Aneurysms: A Systematic Approach to Reducing Ischemic Complications in an Experience with 146 Patients.
| العنوان: | Microsurgical Clipping of Anterior Choroidal Artery Aneurysms: A Systematic Approach to Reducing Ischemic Complications in an Experience with 146 Patients. |
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| المؤلفون: | Winkler EA; Department of Neurological Surgery, University of California - San Francisco, San Francisco, California., Lu A; Department of Neurological Surgery, University of California - San Francisco, San Francisco, California., Burkhardt JK; Department of Neurological Surgery, University of California - San Francisco, San Francisco, California.; Department of Neurosurgery, Baylor College of Medicine Medical Center, Houston, Texas., Rutledge WC; Department of Neurological Surgery, University of California - San Francisco, San Francisco, California., Yue JK; Department of Neurological Surgery, University of California - San Francisco, San Francisco, California., Birk HS; Department of Neurological Surgery, University of California - San Francisco, San Francisco, California., Alotaibi N; Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada., Choudhri O; Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Lawton MT; Department of Neurological Surgery, University of California - San Francisco, San Francisco, California.; Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona. |
| المصدر: | Operative neurosurgery (Hagerstown, Md.) [Oper Neurosurg (Hagerstown)] 2019 Oct 01; Vol. 17 (4), pp. 413-423. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 101635417 Publication Model: Print Cited Medium: Internet ISSN: 2332-4260 (Electronic) Linking ISSN: 23324252 NLM ISO Abbreviation: Oper Neurosurg (Hagerstown) Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc. Original Publication: Hagerstown, MD: Lippincott, Williams & Wilkins, 2014- |
| مواضيع طبية MeSH: | Aneurysm, Ruptured/*surgery , Cerebral Infarction/*epidemiology , Intracranial Aneurysm/*surgery , Intraoperative Complications/*epidemiology , Microsurgery/*methods , Neurosurgical Procedures/*methods , Postoperative Complications/*epidemiology, Adult ; Aged ; Aneurysm, Ruptured/epidemiology ; Cerebral Angiography ; Coloring Agents ; Female ; Humans ; Indocyanine Green ; Intraoperative Neurophysiological Monitoring ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Surgical Instruments ; Ultrasonography |
| مستخلص: | Background: Aneurysms of the anterior choroidal artery (AChA) have been associated with high treatment-associated morbidity due to ischemic complications. Objective: To report a large clinical experience of microsurgically treated AChA aneurysms and describe a systematic approach to reduce ischemic complications. Methods: One hundred forty-six patients with AChA aneurysms were retrospectively reviewed from a prospectively maintained database. Clinical characteristics, surgical techniques, clinical outcomes, arterial infarction, and use of intraoperative adjuncts (ie, ultrasonography, indocyanine green videoangiography, and neuromonitoring) were analyzed. Results: In total, one hundred forty-three aneurysms (97.9%) were clipped. Temporary clipping was utilized in 47 cases (32.2%) with mean occlusion time of 5.6 min. Arterial infarction occurred in 12 patients (8.2%). In clipped aneurysms, 90.5% were completely obliterated, 8.8% had minimal residual (<5% of original), and 0.7% were incompletely occluded (>5% of original). Mortality (2.7%) was limited to patients with high-grade subarachnoid hemorrhage. Indocyanine green videoangiography and neuromonitoring altered operative technique in ∼20% of cases. Multivariate logistic regression identified intraoperative rupture as the sole predictor for arterial infarction. Conclusion: Open microsurgical clipping remains a safe, effective treatment for AChA aneurysms. Microsurgical technique is paramount in preserving AChA patency and reducing ischemic complications. Despite increasing reliance on qualitative measures of AChA blood flow (videoangiography and ultrasonography) and neurophysiological monitoring, these technologies aid us infrequently. However, these adjuncts provide important safety checks for AChA patency. Temporary clipping must be used judiciously to lower the risk of intraoperative rupture while limiting possible ischemia in the AChA territory. (Copyright © 2019 by the Congress of Neurological Surgeons.) |
| التعليقات: | Comment in: Oper Neurosurg (Hagerstown). 2019 Oct 1;17(4):E145-E146. (PMID: 30888035) Comment in: Oper Neurosurg (Hagerstown). 2019 Oct 1;17(4):E143-E144. (PMID: 31058979) Erratum in: Oper Neurosurg (Hagerstown). 2019 Jul 1;17(1):113. (PMID: 31197346) |
| فهرسة مساهمة: | Keywords: Aneurysm clipping; Anterior choroidal artery aneurysm; Microsurgical treatment; Stroke; Subarachnoid hemorrhage |
| المشرفين على المادة: | 0 (Coloring Agents) IX6J1063HV (Indocyanine Green) |
| تواريخ الأحداث: | Date Created: 20190328 Date Completed: 20201013 Latest Revision: 20201013 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1093/ons/opz007 |
| PMID: | 30915448 |
| قاعدة البيانات: | MEDLINE |
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