Anterior Choroidal Artery Aneurysm: Clipping Strategies

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Clip ligation of anterior choroidal aneurysms can we somewhat tricky. Let's review this interesting case of a 50-year-old female who presented with a six millimeter anterior choroidal aneurysm. You can see the morphology of the aneurysm rather dysmorphic making one concerned about the risk of hemorrhage. Most anterior choroidal arteries originate from the neck of their aneurysms. Patient subsequently underwent a left frontotemporal craniotomy. You can see the ICA, the aneurysm and the origin of the anterior choroidal artery at the neck of the aneurysm. Since the aneurysm wraps around the neck of the aneurysm, I attempt to find the more distal part of the artery around the distal neck of the aneurysm. In this case, it was relatively difficult to find the distal pathway of the artery. Temporal occlusion of the IC was used. I could estimate the pathway of the artery. Here you can see potentially a very limited view of the artery. A bayoneted clip was used so I can better visualize around the tip of the clip blades, protecting the origin of the anterior choroidal artery. Micro-Doppler probe confirmed patency of the anterior choroidal wrapping along the posterior aspect of the neck. ICG angiogram and demonstrates patency of the origin of the anterior choroidal artery, in addition to patency of the distal part of the artery. Here, you can see some faint feeling of the distal segment of the anterior choroidal artery, and postoperative angiogram demonstrated complete exclusion of the aneurysm with patency of the anterior choroidal artery, and the CT scan excluded any evidence of ischemia, and this patient recovered from her surgery very well. Thank you.

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