We describe a rare case with partially thrombosed fusiform anterior choroidal artery (AchA) aneurysm successfully treated with therapeutic occlusion of the AchA.
A 58-year-old man presented with transient mild hemiparesis of the right side. Magnetic resonance imaging (MRI) showed an ischemic lesion in the posterior limb of the left internal capsule. Digital subtraction angiography (DSA) revealed a left internal carotid artery saccular aneurysm (14.5-mm diameter) arising from the supraclinoid segment. The left AchA was not detected in the initial DSA, and MRI showed the aneurysm to be partially thrombosed. The second DSA performed 2 weeks after the onset showed recanalization of the thrombosed portion of the aneurysm with the left AchA apparently arising from its tip. The aneurysm was diagnosed as a partially thrombosed fusiform AchA aneurysm.
Open surgery was performed and a titanium clip was applied to the base of the fusiform aneurysm under motor evoked potential monitoring, which remained unchanged after clipping. Occlusion of the aneurysm was confirmed by Doppler ultrasound and intraoperative fluorescence angiography. Furthermore, Doppler ultrasound and fluorescence angiography showed that the blood flow supplying the pyramidal tract was reconstituted by the retrograde collateral flow from the choroidal segment. The aneurysm was completely obliterated in postoperative DSA, which demonstrated retrograde filling of the AchA through the posterior circulation. The patient manifested transient weakness of the right side postoperatively, which was completely recovered after short-term rehabilitation.
This case illustrates the unique clinical course of a rare partially thrombosed fusiform AchA aneurysm, successfully treated with therapeutic clip occlusion of the AchA under the multimodal monitoring.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Stroke and Cerebrovascular Diseases
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Microneurosurgery. Clinical considerations, surgery of the intracranial aneurysms and results.Georg Thieme Verlag, Stuttgart, New York1984: 99-108
- Endovascular coil embolization of a ruptured distal anterior choroidal artery aneurysm associated with ipsilateral middle cerebral artery occlusion–case report.Neurol Med Chir. 2011; 51: 716-719
- Microneurosurgical management of anterior choroid artery aneurysms.World Neurosurg. 2010; 73: 486-499
- A pediatric patient with a dissecting thrombotic anterior choroidal artery aneurysm: case report.Neurosurgery. 2010; 67: E518
- Endovascular treatment of anterior choroidal artery aneurysms.AJNR Am J Neuroradiol. 2004; 25: 314-318
- Ischemic complications of surgery for anterior choroidal artery aneurysms.J Neurosurg. 2001; 94: 565-572
- Surgical treatment of 127 anterior choroidal artery aneurysms: a cohort study of resultant ischemic complications.Neurosurgery. 2013; 73 (discussion 9-40): 933-939
- Endovascular coil embolization of anterior choroidal artery aneurysms. Clinical article.J Neurosurg. 2009; 111: 963-969
- Retrograde filling of the anterior choroidal artery: vertebral angiographic sign of obstruction in the carotid system.Neuroradiology. 1992; 34: 504-507
- Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery.J Neurosurg. 2003; 98: 507-514
- Intraoperative microvascular Doppler sonography in aneurysm surgery.Neurosurgery. 1997; 40 (discussion 70-2): 965-970
- The efficacy of motor-evoked potentials on cerebral aneurysm surgery and new-onset postoperative motor deficits.J Neurosurg Anesthesiol. 2010; 22: 247-251
- Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery.J Neurosurg. 2007; 107: 68-73
- Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography.Neurosurgery. 2007; 61 (discussion -3): 63-72
Published online: May 13, 2015
Accepted: April 17, 2015
Received in revised form: April 11, 2015
Received: January 29, 2015
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.