Case ReportRuptured Distal Anterior Choroidal Artery Aneurysm Treated with Superselective Provocative Testing and Coil Embolization
Section snippets
Background and Importance
Aneurysms of the anterior choroidal artery are uncommon, and those located on the distal aspect of this artery are even rarer, with only 34 cases reported in the medical literature, 16 of which were associated with moyamoya disease.1 Presentation often includes intracerebral hemorrhage, though subarachnoid hemorrhage has been reported for aneurysms of the cisternal segment.2 These lesions have been most commonly reported in association with vascular disease or arteriovenous malformations.3, 4
History
A 40-year-old man was transferred to our center with the acute onset of a thunderclap headache with associated nausea and vomiting. Symptoms began immediately following orgasm, as has been previously reported.10 Medical history was notable for asthma and scoliosis, corrected surgically. Social history was notable for occasional alcohol use but negative for the use of tobacco or other drugs. There was no family history of aneurysms or vascular disease.
Examination
Upon examination the patient was afebrile
Discussion
The anterior choroidal artery arises from the posterior wall of the internal carotid artery and travels in the subarachnoid space before entering the lateral ventricle by piercing the choroidal fissure. Before entering the choroidal fissure, the anterior choroidal artery gives off multiple perforators to the posterior limb of the internal capsule, optic tracts, lateral thalamus, and globus pallidus. Distal to the plexal point occlusion is usually inconsequential, though large and important
Conclusions
Distal anterior choroidal aneurysms are uncommon lesions that can be challenging to treat. They often occur in association with high-flow conditions, such as moyamoya disease and arteriovenous malformations, but can occur in isolation. Endovascular treatment with coil embolization is feasible and offers favorable outcomes in limited reports. Neurointerventionalists treating aneurysms of the distal anterior choroidal artery and similar lesions requiring occlusion of a critical vessel should
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Cited by (8)
Endovascular management of ruptured choroidal aneurysms associated with moyamoya syndrome: A two-patient case report & review of the literature
2021, Clinical Neurology and NeurosurgeryCitation Excerpt :However, there is potential for reflux in the setting of liquid embolization agent occluding the proximal AChA and associated perforators. With these concerns in mind Schmalz et al. successfully employed coil embolization in a patient without MMS who presented with a distal AChA aneurysm located proximally to the plexal point [20]. Furthermore, despite which operative route is used whether it be surgical or endovascular, two important factors that drive the success of intervention in the treatment of moyamoya distal AChA aneurysms are the aneurysm location and preservation of the parent artery especially when the aneurysm is in the trigone of the lateral ventricle [2].
Clinical features, surgical treatment, and outcome of intracranial aneurysms associated with moyamoya disease
2020, Journal of Clinical NeuroscienceCitation Excerpt :What‘s more, there were 65 patients received brain perfusion, and 33 (58.9%) of 56 surgical patients have an improvement in cerebral and 2 (18.2%) of 11 conservative patients 3 months after discharge (P < 0.05). Due to the low incidence of intracranial aneurysms associated with MMD, most studies on the intracranial aneurysms associated with MMD were just case reports [8–13]. Kim et al reported that the incidence of intracranial aneurysms associated with MMD in adult MMD was 8.3% [14], Liu et al has reported the incidence rate of 1.9% in pediatric patients [15], and Takahashi et al reported the prevalence of aneurysm formation in cases of adult MMD is approximately 14%n [5].
Role of the anterior choroidal artery in the endovascular treatment of brain arteriovenous malformations
2023, Acta Neurologica BelgicaParent artery occlusion for ruptured aneurysms in moyamoya vessels or on collaterals
2023, Frontiers in NeurologyEndovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma
2022, Frontiers in NeurologyNano coils in endovascular treatment of anterior choroidal artery micro-aneurysms
2021, Chinese Journal of Clinical Research
Conflict of interest statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors declare neither personal nor institutional conflicts of interest.