Analysis Of Treatment On43Cases Of Anterior Choroidal Artery Aneurysms

Background:Spontaneous subarachnoid hemorrhage (SAH) is a common cerebrovascular disease with a high rate of mortality and disability, which is always caused by ruptured intracranial aneurysm. Anterior choroidal artery aneurysm (AChAA) accounts for2%-5%of intracranial aneurysm. Anterior choroidal artery (AChA) supplies the posterior limb of the internal capsule, globus pallidus, optic tract, hippocampus and many other important brain structures. Improper treatment may produce the occlusion of AChA terminal branches and poor collateral circulation, causing anterior choroidal artery syndrome(AChAS). The presentation of AchAS includes contralateral hemiplegia, hemidysesthesia, hemianopia, and dysarthria. Treatment of AchAA poses chalenges due to its critical anatomy. The main treatment methods of AChAA consists of surgical clipping and endovascular coiling. Both treatment methods have advantages and disadvantages. There is dilemma between physicians selecting treatment methods.Objective:To investigate the difference of postoperative recovery and prognosis between patients with AChAA in surgical clipping group and endovascular embolization group. Methods:We retrospectively analyze43cases of patients with AchAA admitted from January2011to December2013, treated in the Second Affiliated Hospital of Zhejiang University Department of Neurosurgery with complete clinical data. The patients were dichotomized according to the modality of treatment, the coil group(23patients) and the clip group (20patients). The AChAA were sorted into type A and type B according to whether the AChA arise from the aneurysm (type A, the AChA doesn’t arise from the aneurysm or aneurysm neck; type B, an AChA arises from the aneurysm or aneurysm neck). We compare and analyze the preoperative state, Hunt—Hess grading(H&H), age, neck type, postoperative3months follow-up modified Rankin score(m3RS) of both groups.Results:①87%(20/23) patients in the coil group have good recovery after discharge(m3RS level<2),17.4%(4/23) patients suffered ischemic complication after coiling and4.3%(1/23) recovered after treatment later.90%(18/20) patients in the clip treatment group have good recovery after discharge.25%(5/20) patients suffered ischemic complication after clipping and15%(3/20) recovered after treatment later. There is no significant difference in outcome of3months follow-up between the two groups (P>0.05).②The outcome of patients with H&H I-III has no significant difference between the two groups (P>0.05).③The outcome of patients with the same age-group has no significant difference between the two groups (P>0.05).④The outcome of patients with type A and type B AChAA has no significant difference between the two groups.⑤The average days of hospital stay in coil group is significantly less than that in the clip group (P<0.05).Conclusion:①In this study, the outcome of AChAA treated with coiling or surgical clipping is similar.②Compared with clip group, coil group experiences more rapid postoperative recovery. The average days of hospital stay is less in the coil group.