Download Microsurgical Clipping of a Small Anterior Choroidal Artery Aneurysm: Technical Pearls
Microsurgical Clipping of a Small Anterior Choroidal Artery Aneurysm: Technical Pearls
Microsurgical Clipping of a Small Anterior Choroidal Artery Aneurysm: Technical Pearls
This case is a presentation of technical tenets for the microsurgical clipping of an anterior choroidal artery aneurysm. This video was deemed IRB exempt by the Institutional Review Board (IRB) as it ...
This case is a presentation of technical tenets for the microsurgical clipping of an anterior choroidal artery aneurysm. This video was deemed IRB exempt by the Institutional Review Board (IRB) as it is considered a case report, which does not require IRB approval or patient consent. The patient described in this case was a 75-year old female who presented with the worst headache of her life, involving the left side of her head. The patient was found to have a CT negative, LP positive subarachnoid hemorrhage, from a 4-5 mm left anterior choroidal artery aneurysm on angiographic studies. Endovascular options were considered to be high risk for this patient, due to the small size, wide neck of the aneurysm as well as multiple choroidal perforators. Stent coiling was not considered the best option given the concern for a subarachnoid hemorrhage. The patient described in this case made an uncomplicated post-operative recovery and was discharged to home, without developing vasospasm or any other subarachnoid associated complications. This case is valuable to the literature as anterior choroidal aneurysms are small and treacherous, thus it is important to not over clip these aneurysms, a key technical note illustrated in this video. Considering that these arteries are quite unforgiving with multiple perforators and supply posterior limb of internal capsule, thalamus and optic tract; it is important to utilize all operative adjuncts during these cases such as indocyanine green angiography, intraoperative cerebral angiography as well as neurophysiologic monitoring particularly motor evoked potentials.
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