Aneurysm of superior branch of anterior choroidal artery mimicking carotid bifurcation aneurysm — Case report

Summary Aneurysm of the superior branch of anterior choroidal artery is very rare. We report this rare case with unique angiographic findings mimicking an internal carotid bifurcation aneurysm.A 35-year-old woman was admitted to our hospital because of severe headache. Lumbar puncture disclosed numerous red blood cells. Computed tomography revealed an enhanced circular area in the left basal cistern with moderate hydrocephalus. Cerebral angiography showed a saccular aneurysm near the left internal carotid bifurcation. During operation, the aneurysm was not found at the internal carotid bifurcation, but located deeper budding from the superior branch of the anterior choroidal artery. The aneurysm was successfully clipped. The postoperative course was favourable without any neurological deficit.The postoperative angiogram showed that the aneurysm was clipped well with preservation of the main trunk of the anterior choroidal artery. Computed tomography of the brain did not show any infarction area, 3 months after the surgery. The uniqueness of this case is the favourable outcome after sacrificing the superior branch of the anterior choroidal artery. The role of collaterals of the anterior perforating substance is emphasized.     

Successful intra-arterial fibrinolysis of the anterior choroidal artery in the acute stage of internal carotid artery occlusion: Case report

A 27-year-old man was admitted to our institution with the sudden development of right hemiparesis and dysarthria beginning an hour after the onset of symptoms on August 9, 1992. The patient was found on admission to have right hemiparesis (2/5), hemihypesthesia, hemianopia, dysarthria; he had transient atrial fibrillation. No abnormalities were detected on computed tomography (CT) scans, and cerebral blood flow studies undertaken following conventional CT scans revealed no low flow regions in the left cerebral hemisphere. But cerebral angiography disclosed an occlusion of the left internal carotid artery with well-developed cross-circulation via the anterior communicating artery and embolus lodged at the level of the anterior choroidal artery. Superselective fibrinolysis using Tracker-18 and 420,000 units of urokinase resulting in complete recanalization of the left anterior choroidal artery without distal migration of the embolus. Immediately after the procedure, his neurologic disturbance underwent complete resolution.

In summary, fibrinolysis could be performed but limited to anterior choroidal artery in a case with an occlusion of the internal carotid artery with well-developed cross-flow via the anterior communicating artery; the patient's neurologic condition may deteriorate suddenly if fibrinolysis is incomplete and the embolus migrates to the internal carotid artery.     

Extravasation from anterior choroidal artery in a child with moyamoya disease--case report.

A rare association of moyamoya disease with intra- and periventricular hemorrhage in an 8-year-old girl is presented. Angiography showed that the cause of hemorrhage was extravasation from the dilated anterior choroidal artery. Ventriculoperitoneal shunt and encephalomyosynangiosis have prevented clinical or neurological deficits for over 6 years.     

Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa. Case report.

Polyarteritis nodosa (PAN) is a rare systemic necrotizing arteritis that involves small- and medium-sized arteries in various organs. Although aneurysm formation in visceral arteries is a typical finding in PAN, intracranial aneurysms are much less common, and only a few cases of aneurysm rupture associated with this disease have been documented. In this paper, the authors report on a ruptured PAN aneurysm of the anterior cerebral artery; the lesion was trapped and resected. On histological examination, extensive fibrinoid necrosis and an inflammatory infiltration of leukocytes were seen in the aneurysm wall. To the authors' knowledge this is the first report of subarachnoid hemorrhage from a histologically confirmed PAN aneurysm.     

Distal anterior choroidal artery aneurysms

BACKGROUND: Distal AChoA aneurysms are quite rare. Only 12 operated cases have been reported in the English medical literature. Treatment of these aneurysms is also difficult because of their deep location, small size, and angioarchitecture. METHODS: The authors report 2 additional patients with aneurysms, arising from the distal AChoA and located within the temporal horn of the lateral ventricle. In the first patient, the aneurysm could also be visualized with CTA, which is the first demonstration in the literature. RESULTS: The aneurysms were explored and resected via a transtemporal/ventricular approach in both patients. One patient was discharged as neurologically intact and the other died because of severe vasospasm. CONCLUSIONS: The conclusions drawn from our experience and a comprehensive review of the literature include the following: (1) A distal AChoA aneurysm should be considered in patients with isolated medial temporal intracerebral hematoma with intraventricular extension. (2) These aneurysms are frequently very small (<5 mm). Therefore, they cannot be detected on initial angiograms in some cases. (3) These small aneurysms cannot be usually clipped without sacrificing the parent artery. (4) Sacrificing distal AChoA (beyond the plexal point) does not usually cause any neurological deficit, but, whenever possible, this artery should be preserved.     

Microsurgical anatomy of the anterior choroidal artery

Summary The anterior choroidal artery (A.ch.a.) was studied in 140 hemispheres of the human brain. In 50 specimens the artery was cannulated and perfused with acrylic resin, in 20 specimens the A.ch.a., was selectively cannulated and perfused with dye. The artery then was microsurgically dissected and photographically documented.The site of origin of the A.ch.a., its length, outer diameter, course, branching patterns, anastomoses, and areas of supply was recorded. The surgical and diagnostic significance of the A.ch.a. and its importance during surgical procedures are discussed.     

Microsurgical anatomy of the anterior choroidal artery

The anatomy of the anterior choroidal artery was studied in 25 adult brains (50 cerebral hemispheres). The point of origin and the distribution of this artery were determined. The surgical and clinical implications of these findings are discussed.     

Subarachnoid hemorrhage from a dissecting aneurysm of the middle cerebral artery. Case report

A case of subarachnoid hemorrhage (SAH) from a dissecting aneurysm of the inferior limb of the middle cerebral artery is reported. The patient's clinical status and the initial and follow-up angiographic appearance of the aneurysm are presented. Diagnosis and treatment are briefly discussed. It is suggested that, if angiography demonstrates luminal narrowing or vascular occlusion in a patient with unexplained SAH, a dissecting aneurysm of the carotid system should be considered as a cause of the hemorrhage.     

脉络膜前动脉瘤的显微手术治疗

目的 总结脉络膜前动脉瘤的手术治疗经验.方法 回顾性分析显微手术治疗的12例脉络膜前动脉瘤患者的临床资料,对患者的临床特点、治疗结果及手术并发症进行分析.结果 12例脉络膜前动脉瘤均成功夹闭,术中破裂2例.2例出现一过性轻偏瘫,无死亡病例.随访6～36个月,无术后再出血病例,1例出现迟发性脑积水行分流手术.结论 脉络膜前动脉瘤的手术治疗可以取得良好的效果,保护载瘤动脉及周围穿支血管是术后无缺血性并发症的关键.     

A ruptured choroidal artery aneurysm of the anterior inferior cerebellar artery obliterated via the endovascular approach: case report

Intraventricular aneurysms associated with fourth ventricular hemorrhage are rare. A case of a ruptured aneurysm in a choroidal branch of the right anterior inferior cerebellar artery (AICA) is reported here. A 56-year-old man presented with sudden onset of vertigo and nausea. CT scan showed an intraventricular hemorrhage within the fourth ventricle. Cerebellar angiography showed an aneurysm at the choroidal artery branching from the right AICA. The patient rejected both general anesthesia and craniotomy, so endovascular embolization under local anesthesia was performed using Guglielmi detachable coils (GDCs) and a fibered platinum coil. The distal portion of the right AICA and the aneurysm were obliterated. His postoperative course was fairly satisfactory. He suffered from a minimal gait disturbance caused by truncal ataxia for several days after the operation. He was discharged from hospital without neurological deficit. There have been only a few articles about choroidal artery aneurysms. As treatment, direct surgery has been recommended in past cases, but endovascular embolization of the parent artery was successfully performed in this case. Not only direct surgery but also endovascular surgery may be regarded as the treatments of choice for intraventricular aneurysms, depending on the size of the parent artery.     

Cerebellar infarction resulting from traumatic occlusion of a vertebral artery. Case report.

A case is reported of a patient who suffered a gunshot wound of the neck which resulted in occlusion of a vertebral artery. Within a few hours he deteriorated neurologically to a comatose state with a gaze paresis and a facial paresis ipsilateral to the occluded vertebral artery. The diagnosis of cerebellar infarction with brain-stem compression was made clinically, and a posterior fossa decompression was carried out promptly. The patient has made an excellent recovery. Cerebellar infarction, like cerebellar hemorrhage, may act as a posterior fossa mass requiring neurosurgical decompression. This report emphasizes that such a pathological process may occur after certain injuries that are likely to result in occlusion of a vertebral artery.     

Giant meningioma fed by the anterior choroidal artery: successful removal following embolization--case report.

A 53-year-old female was admitted with apathy, left sensory and motor disturbance, left homonymous hemianopsia, and dressing apraxia. Computed tomography and magnetic resonance imaging showed a huge mass markedly enhanced in and around the right trigone. Cerebral angiography revealed rich vascularity of the tumor mainly fed by the right anterior choroidal artery. The feeding vessel was embolized with microfibrillar collagen after superselective catheterization. Seven days later, the tumor was totally removed with low blood loss. The histological diagnosis was fibroblastic meningioma. She was discharged without neurological deficit, except for left homonymous hemianopsia.     

Pseudoaneurysm of the cystic artery with upper gastrointestinal hemorrhage. Case report

A rare case of pseudoaneurysm of the cystic artery caused by acute cholecystitis is reported. During the severe inflammatory process the common bile duct, duodenum and transverse colon were eroded, in addition to the cystic artery. Findings at computed tomography prompted celiac angiography, which confirmed the preoperative diagnosis. Surgery was successful.