Abstract
There are landmarks on the course of the anterior choroidal artery (AChoA), such as the original point (OP) and the plexal point (PP), as documented in previous articles. In these previous articles, the AChoA was the terminal branch of the internal carotid artery (ICA), which had two segments throughout its course. The first cisternal segment began from the origin and ended at the point where the artery reached the choroidal fissure (the PP). The second segment consisted of one or more branches, which passed through the choroidal fissure and entered the choroid plexus. However, we found another angiographic landmark, named the most external point (MEP), along the course of the AChoA in the anteroposterior (AP) view. There was a sharp turn at the outermost limit of the course of the AChoA, and then the AChoA progressed inward and upward. We defined the outermost limit as the MEP of the AChoA. This study describes two rare cases of distal AChoA aneurysms associated with arteriovenous malformation (AVM) and Moyamoya disease that developed intraventricular hemorrhage, and we used the parent artery occlusion (PAO) technique to embolize the distal AChoA lesions at the MEP. The patients recovered well without any neurological complications.
Highlights
Reports on distal anterior choroidal artery (AChoA) aneurysms are extremely rare; until now, fewer than 50 cases have been reported in the literature [1]
The distal AChoA aneurysm and the AChoA beyond the most external point (MEP) were embolized by coils (Axium; 2 mm × 3 cm, 2 mm × 1 cm), and digital subtracted angiography (DSA) of the internal carotid artery (ICA) showed that there was no retrograde filling of the aneurysm by collaterals and that the ipsilateral capsulothalamic artery had been retained (Figures 4D,E)
The AChoA might send off a few small recurrent perforating branches that exit the temporal lobe through the choroidal fissure to supply the optic tract, the cerebral peduncle, and the thalamus [3]
Summary
Reports on distal anterior choroidal artery (AChoA) aneurysms are extremely rare; until now, fewer than 50 cases have been reported in the literature [1]. Distal AChoA aneurysm and the AChoA beyond the MEP were embolized by coils (Axium; 2 mm × 3 cm, 2 mm × 1 cm), and DSA of the ICA showed that there was no retrograde filling of the aneurysm by collaterals and that the ipsilateral capsulothalamic artery had been retained (Figures 4D,E). Postoperative head CT revealed that the intraventricular hemorrhage had disappeared, and the coils were cast just in the location of the distal AChoA aneurysm in the occipital horn of the lateral ventricle (Figure 4F). The patient recovered well postoperatively, and 1-year follow-up examination revealed that no rebleeding had occurred
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