Abstrakt
Aim: Anterior choroidal artery aneurysms (AChoAA) belong to less frequent cerebrovascular lesions and therefore there are still only a few reports describing their neurosurgical management. We decided to share our experience and present two unusual cases of AChoAA we have treated in our department.
We also report one of the first published use of the Yasargil T-bar fenestrated clip for solving of a AChoAA. Methods: We present two cases of unruptured AChoAA treated in 2016 with respect to patient's history, radiological and microsurgical anatomy of the aneurysm, surgical procedure and clinical follow-up.
Results: Both aneurysms were successfully treated with surgical clipping. In case 1 we used a single T-bar fenestrated clip.
To our best knowledge this might be the first reported use of such clip in treatment of AChoAA. In case 2 for a large AChoAA a standard straight Aesculap clip was used.
Both procedures were performed with microvascular Doppler sonography and under electrophysiological monitoring with motor-evoked potentials (MEP). Temporary disturbance in MEP signal during surgery was observed in the T-bar clip case and led to reposition of the clip.
Both patients had a good surgical outcome without any clinical or radiological signs of ischemia in the AChoA or any other territory. Conclusion: As previous literature we confirm that surgical treatment of AChoAA is a good and safe alternative to endovascular treatment.
We propose, using T-bar fenestrated clip might be appropriate solution for treatment of these lesions. We also suggest that combination of monitoring methods (MVDS, ICG and MEP monitoring) during AChoAA surgery is a very valuable way for prevention of ischemic infarction in the AChoA territory.