An unusual, duplicate origin of the anterior choroidal artery with aneurysm: a case report

Accessory posterior cerebral artery as a duplicate anterior choroidal artery

PURPOSE

Anatomical variations in the anterior choroidal artery (AChA) and/or the posterior cerebral artery (PCA) are rare. Hyperplastic AChA is an anatomical variant supplying both the AChA area and the PCA area. In accessory PCA, a hyperplastic AChA supplies part of the PCA territory. To our knowledge, there are no previous reports of accessory PCA associated with duplicated AChAs.

METHODS

We report a case of accessory PCA as a duplicated AChA associated with contralateral accessory middle cerebral artery, diagnosed by digital subtraction angiography.

RESULTS

A 34-year-old man visited our hospital because of headache and neck pain. Magnetic resonance imaging showed flow voids around the left medial temporal lobe. Magnetic resonance angiography showed vascular structures in the left PCA. Left internal carotid angiography revealed the accessory PCA supplying not only the AChA (plexal segment) territory but also part of the PCA (anterior and posterior temporal arteries) territory. Three-dimensional rotational angiography revealed a tiny branch proximal to accessory PCA. Careful assessment revealed that the tiny branch perfused the left AChA (cisternal segment) territory. Therefore, we made a diagnosis of duplicated AChAs. Right internal carotid angiography also showed the accessory middle cerebral artery originating from the anterior cerebral artery (proximal A1 segment).

CONCLUSION

Careful imaging assessment is important to identify the rare anatomical variations seen in this case, in which three-dimensional rotational angiography was useful and provided a better understanding of the vascular structure, including tiny vessels.

Distribution of branches of anterior choroidal artery in the uncus: an anatomical study

The aim of our study was to examine the relationship between uncus and uncal branches of anterior choroidal artery (AChA) and to observe the morphological and morphometric features of these branches. 124 hemispheres from 62 fresh cadavers were included in the study. Measurement of the length of AChA and the distances of the uncal branches to the origin of AChA were measured by ImageJ software. Morphological variations of uncal branches originating from AChA were observed. The length of AChA was found as mean 26.24 ± 4.34 mm. It was determined that the average distance of these uncal branches arising from the AChA was 13.48 ± 7.31 mm. In 4 out of 124 AChAs, no branches were observed. 594 branches originating from 120 were detected. 130/594 branches appeared to be terminal branches. AChAs of 80/120 hemispheres have been reported to have uncal branches. Thirty of 130 uncal branches were observed to originate as the first branch of AChA. It was found that uncal branches may originate from AChA with a variability between 1 and 4. When evaluated according to the origin of each branch from the AChA, it was observed that the uncal branches originated from the midpoint of the AChA on average. Also, in 64 hemispheres, morophological variations were detected regarding the origin of uncal branches. We believe that the morphological and morphometric data we obtained from the uncal branches of the AChA are of clinical importance in terms of understanding this complex region and minimizing errors in surgical procedures.

Case Report: “Clipping” an Internal Carotid Artery Aneurysm With a Duplicated Middle Cerebral Artery and the Anterior Choroidal Artery Arising From the Dome

Background

A duplicated middle cerebral artery (DMCA) is an anatomical variant that includes duplication of the middle cerebral artery (MCA) and an anomalous vessel originating between the anterior choroidal artery (AChA) and the distal end of the internal carotid artery (ICA). Here, we present a case report of an ICA aneurysm with a DMCA and the AChA originating from the dome, which was successfully treated with clipping.

Case Description

In a 64-year-old man, preoperative angiography revealed an unruptured right ICA aneurysm with a maximum diameter of 4.3 mm, and fusion three-dimensional computer graphics revealed that a DMCA and the AChA originated from the dome. The aneurysm enlarged; therefore, clipping was performed. The closure of the aneurysm while preserving the patency of the DMCA and AChA was identified using intraoperative microvascular Doppler ultrasonography and indocyanine green video angiography. The postoperative course was uneventful, and no ischemic lesions were confirmed on MR imaging.

Conclusion

To the best of our knowledge, this is the first report of an ICA aneurysm with a DMCA and the AChA arising from the dome. In such cases, the anatomy of the DMCA and AChA should be well-characterized before treatment.

Common origin of the anterior choroidal artery and posterior communicating artery with a concomitant aneurysm at the internal carotid artery-posterior communicating artery junction: A case report

The anterior choroidal artery (AChA) is one of the main arteries, and it can exhibit several anomalies, among which is the common origin of the AChA and posterior communicating artery (PcomA); however, this is relatively rare. In the case that the AChA originates from the PcomA, it is highly uncommon for a concomitant aneurysm to develop at the internal carotid artery (ICA)-PcomA junction. The present study reports such a case. A 58-year-old female developed a headache with nausea and vomiting. Computed tomography (CT) revealed a subarachnoid hemorrhage. CT angiography and digital subtraction angiography (DSA) revealed a right ICA-PcomA aneurysm, with the AChA arising from the proximal segment of the PcomA. The aneurysm was clipped in the hybrid operating room. DSA confirmed that the aneurysm had been clipped completely, and that the PcomA and AChA had been retained. Following surgery, the patient recovered well without any sequelae. CT angiography revealed no recurrence of the aneurysm at the 3-month follow-up. On the whole, as demonstrated by the case presented herein, when the AChA and PcomA have a common origin, the AChA and PcomA should be retained during concomitant aneurysm clipping at the ICA-PcomA to prevent severe infarction complications. Surgical clipping during hybrid surgery is a suitable choice.

Duplicated Anterior Choroidal Arteries: Literature Review and Clinical Implications

The anterior choroidal artery supplies important cerebral structures. One important variation of this vessel is duplication. However, little is reported on this anatomical variant and moreover, the prevalence of such a finding varies widely. Therefore, here, we review the literature regarding duplicated anterior choroidal arteries. Clinicians reviewing imaging of the brain, interventionalists, or neurosurgerons should be knowledgeable of variations of the anterior choroidal artery, including its duplication. A better understanding of this anatomy and embryology can improve diagnoses and patient outcomes following interventional or open neurosurgical techniques.