| ObjectiveCombined with clinical characteristics and classification of anterior choroidal artery aneurysm,explore factors affecting the prognosis of anterior choroidal artery aneurysm to provide a reference for improving the postoperative outcome.MethodsThe clinical data of 86 patients with anterior choroidal artery aneurysms who underwent surgical treatment in Affiliated Hospital of Qingdao University from December 1997 to December 2018 were retrospectively collected and analyzed.All patients were confirmed to have anterior choroidal artery aneurysm.The prognostic assessment was based on the general condition of the patient at the 6-month follow-up,and the prognosis was evaluated based on the Modified Rankin Scale(mRS).Combined with the classification related to morphological characteristics of AChAA,and the new classification of CT features of subarachnoid hemorrhage(SAH)caused by anterior choroidal artery aneurysm,explore the factors affecting the surgical prognosis in patients with anterior choroidal artery aneurysm.Therapeutic effect was set as the dependent variable.Univariate analysis and multivariate logistic regression analysis were conducted to examine 12 factors that possibly affected the outcomes and included the patient's age,gender,times of subarachnoid hemorrhage(SAH),characteristics of SAH on Computed Tomography(CT)scans,Hunt-Hess grade,aneurysm's side,size,emitting part,pointing,surgical timing,presence or absence of intraoperative aneurysm rupture and presence or absence of postoperative complications.To investigate the incidence and features of AChA ischemia in treatment of anterior choroidal artery aneurysms,5 indicators including characteristics of SAH on CT,times of preoperative SAH,Hunt-Hess grade,aneurysm's size,and aneurysm's emitting part were analyzed by use of the?~2 test and Fisher exact test to analyze its correlation with postoperative ischemic complications.ResultsA total of 111 aneurysms in 86 patients with anterior choroidal aneurysm in this group were successfully clipped.This study is the largest series of anterior choroidal artery aneurysm surgical clipping performed by only one surgeon reported so far,and 80of 86 patients(93.02%)achieved good results.There were 13 cases with postoperative complications,of which 6 patients(6.98%)had postoperative AChA ischemic complication,and the mortality rate was only 5.81%.At a follow-up of 6 months after operation,86 patients with AChAA according to the mRS:78 cases were healing(mRS 0to 1);2 cases were self-care(mRS 2 to 3);only one case was vegetative state(mRS 4 to5);5 patients were death(mRS 6).Furthermore,characteristics of SAH on CT(OR=3.727,P=0.000,95%CI:1.850?7.508),aneurysm's size(OR=6.335,P=0.000,95%CI:2.564?15.647)and presence or absence of postoperative complications(OR=4.141,P=0.000,95%CI:1.995?8.599)were independent risk factors influencing the prognosis.In addition,we found that the incidence of ischemic anterior choroidal artery syndrome is related to the aneurysm emitting part.Aneurysm's emitting part(P=0.000)seems to greatly affect the occurrence of ischemic anterior choroidal artery syndrome.The anatomy of anterior choroidal artery adjacent to or into the neck of an aneurysm can increase the incidence of ischemic anterior choroidal artery syndrome,and that will be more difficult to maintain the patency of the anterior choroid artery.ConclusionCharacteristics of SAH on CT,aneurysm's size and presence or absence of postoperative complications are independent risk factors affecting the surgical outcomes of anterior choroidal artery aneurysms.In addition,the anatomy of anterior choroidal artery adjacent or into the neck of an aneurysm can increase the incidence of ischemic anterior choroidal artery syndrome.Through analysis of these factors,the treatment of anterior choroidal artery aneurysms can be further guided and level of clinical treatment can be improved. |
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