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Objective: This study describes our experiences with anterior choroidal artery (AChA) aneurysm clipping with a focus on visualizing the AChA just behind the aneurysm to identify the risk factors for adhesion of the AChA or its branches to the posterior wall of the AChA aneurysm., Methods: The initial segment of the AChA just behind the aneurysm was evaluated preoperatively using three-dimensional (3D) rotational angiography, and its course was designated as posteromedial, posterior, or posterolateral. The posterior aspect of the AChA aneurysm was inspected intraoperatively using an endoscope or micromirror., Results: Based on 3D rotational angiography, the main trunk of the AChA showed a posteromedial (n = 47, 57.3%), posterior (n = 18, 22.0%), or posterolateral (n = 17, 20.7%) course just behind the aneurysm. Intraoperatively, 14.6% (12 of 82) of the clipped AChA aneurysms revealed an AChA branch adhered to the posterior wall of the aneurysm. A multivariate analysis revealed that the posterior or posterolateral course of the initial segment of the AChA was a statistically significant risk factor for adhesion of an AChA branch to the posterior wall of the aneurysm (odds ratio [OR] 21.083, 95% confidence interval [CI] 2.567-173.166, P = 0.005)., Conclusions: The initial course of the AChA just behind an AChA aneurysm can be evaluated using 3D rotational angiography. In contrast to a posteromedial course, a posterior or posterolateral course of the AChA just behind an AChA aneurysm can be a significant risk factor for adhesion of an AChA branch to the posterior wall of an AChA aneurysm., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The authors used a micromirror under a microscope with an indocyanine green (ICG) imaging system to assess clipped aneurysms and the blood flow in hidden regions during aneurysm surgery. This study then investigated the usefulness of such mirroring with ICG angiography (MICGA)., Methods: A micromirror was used during aneurysm surgery on 25 patients, and MICGA was performed on 10 of these 25 patients to inspect the hidden region after clipping. The mirrored aneurysms were located at the posterior communicating artery (n = 4), anterior choroidal artery (n = 4), proximal A1 segment (n = 1), and middle cerebral artery (n = 1)., Results: In all 10 cases, MICGA was successful in assessing the state of the clipped aneurysm and blood flow of the vessels in the hidden region after clipping. This led to clip repositioning in 3 patients (30.0%) because of incomplete clipping of a hidden aneurysm or occlusion of a hidden perforator. Complete occlusion of the aneurysm was achieved in 8 patients, and the other 2 patients showed near complete occlusion because of an intentional residual aneurysm to avoid a small vessel adherent to the posterior wall of the aneurysm base., Conclusions: MICGA can provide useful and reliable information on the state of a clipped aneurysm and the blood flow of associated vessels and perforators in a hidden region after aneurysm clipping., (Copyright © 2019 Elsevier Inc. All rights reserved.)

• SAH patients with non-PMH generally had uncomplicated clinical courses and favorable outcomes. • Non-Fisher-type 3 pattern was a prognostic factor for favorable outcomes in the non-PMH. • Long-term SAH was a prognostic factor for developing hydrocephalus in non-PMH. Our objective was to analyze functional outcomes and prognostic factors in patients suffering from angiogram-negative non-perimesencephalic subarachnoid hemorrhage (non-PMH). In total, 1601 patients presenting with spontaneous SAH between January 2009 to December 2019 admitted to our institution were reviewed. Among them, 51 patients with angiogram negative non-perimesencephalic subarachnoid hemorrhage were analyzed. We divided patients into groups according to hemorrhage pattern and duration. Prognostic factors were assessed according to initial neurologic grade, early hydrocephalus, fisher grade, and duration of hemorrhage. Outcomes were assessed according to the modified Rankin Scale after 6 months. Overall, 41 patients (80.3%) with angiogram-negative non-PMH achieved a favorable outcome. In univariate analysis, good initial neurologic grade, absence of early hydrocephalus, non-Fisher-type 3 bleeding pattern, and short term hemorrhage (blood wash out <7 days after onset) duration were significantly associated with a favorable outcome. In multivariate analysis, a non-Fisher-type 3 hemorrhagic pattern (p < 0.05) and good initial neurologic state (p < 0.01) were independent predictors of favorable outcomes in angiogram-negative non-PMH patients. Patients with angiogram-negative non-PMH generally had favorable outcomes. A non-Fisher-type 3 hemorrhagic pattern and good initial neurologic state were prognostic factors of a favorable outcome in non-PMH. Furthermore, patients with long-term SAH were more likely to develop hydrocephalus. Evaluating the pattern and duration of subarachnoid hemorrhage may allow better prediction of outcomes in patients with angiogram negative and non-PMH. [ABSTRACT FROM AUTHOR]