Distal anterior choroidal artery aneurysm in a patient with moyamoya disease: case report.
OBJECTIVE
Distal anterior choroidal artery (AChA) aneurysms in moyamoya disease are rare, with few surgically verified reported cases.


METHODS
We report a rare case of distal AChA aneurysm associated with moyamoya disease in a 48-year-old man who presented with vomiting and severe headache. Computed tomographic scans revealed an intracerebral hematoma in the right temporoparietal lobe and a diffuse intraventricular hemorrhage.


METHODS
The hematoma was removed via computed tomography-guided stereotactic aspiration and ventricular drainage. Cerebral angiography showed a saccular aneurysm located at the distal branch of the right AChA. By means of magnetic resonance imaging, a small signal void lesion was detected in the periventricular area lateral to the trigone of the right lateral ventricle. The aneurysm was accurately accessed via a parietal cortical incision by use of magnetic resonance imaging-guided stereotactic localization. The aneurysm was successfully resected after undergoing trapping of the parent artery, and when the patient was discharged, he had no evidence of neurological deficit. The aneurysm was histologically verified to be a true aneurysm.


CONCLUSIONS
Direct surgery should be considered in cases of ruptured distal AChA aneurysms located in the periventricular or intraventricular regions.
Lee
J K
JK
Department of Neurosurgery, Chonnam National University Hospital and Medical School, Kwangju, South Korea. leejk@medikorea.net
Lee
J H
JH
Kim
S H
SH
Lee
M C
MC
D000783:Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002829:Choroid / Q000098:blood supply*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed