Distal anterior choroidal artery aneurysm associated with an arteriovenous malformation. Intraoperative localization and treatment.
BACKGROUND
Distal anterior choroidal artery aneurysms are rare. The outcome of patients with distal anterior choroidal artery aneurysms has been poor, and the treatment of such aneurysms is surgically challenging.


METHODS
The authors describe the case of an 8-year-old girl with a ruptured distal anterior choroidal artery aneurysm associated with an arteriovenous malformation (AVM). The patient experienced sudden onset of headache and vomiting. Computed tomography revealed an intraventricular haemorrhage, and cerebral angiography demonstrated an aneurysm arising from the distal portion of the right anterior choroidal artery. The patient also had an AVM in the ipsilateral temporal lobe fed by the branches of the middle cerebral artery. A right frontotemporal craniotomy was performed with the aid of intraoperative angiography to eliminate both the AVM and the aneurysm. Intraoperative angiography was helpful in confirming the complete removal of the AVM and in accurate localization of the small and deeply placed distal anterior choroidal artery aneurysm. Both the AVM and the aneurysm were successfully treated and the patient was discharged without any neurological deficits.


CONCLUSIONS
This case is the youngest reported patient with a distal anterior choroidal artery aneurysm. This report is also the first to describe an association of such an aneurysm with an AVM. The etiology of the aneurysm formation in this case and surgical strategy for deeply placed vascular lesions are discussed.
Department of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
K
K
Yanaka
K
K
Tsuboi
K
K
Fujita
K
K
Aoki
S
S
Takeuchi
I
I
Anno
T
T
Nose
D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D002648:Child; D002829:Choroid / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008279:Magnetic Resonance Imaging; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000379:methods; D014057:Tomography, X-Ray Computed