title: [Endovascular coil embolization for a ruptured distal anterior choroidal artery aneurysm showing definite short-term enlargement: a case report].
abstract: Distal anterior choroidal artery aneurysms are quite rare, and appropriate treatment timing and methods remain unclear. Direct surgery of these aneurysms is difficult due to their deep location, small size, and angioarchitecture;however, pseudoaneurysms might disappear spontaneously with conservative treatment. A 65-year-old man with a history of hypertension was admitted to our hospital with a 5-day history of sudden headache and nausea. Computed tomography revealed an intraventricular hematoma located mainly in the right lateral ventricle. Cerebral angiography 7 days after onset revealed a right distal anterior choroidal artery aneurysm and proximal right middle cerebral artery occlusion caused by atherosclerotic changes. Endovascular coil embolization was performed under general anesthesia 14 days after onset. Preoperative angiography demonstrated definite enlargement of the aneurysm and stasis of the contrast agent in the aneurysm in the venous phase. Detachable platinum coils were delivered into the aneurysm and parent artery. The patient was discharged neurologically intact after the procedure. Follow-up angiography 3 months after coil embolization showed complete occlusion of the aneurysm. In recent years, endovascular surgery has emerged as a less invasive treatment option. Early treatment should be considered for patients with ruptured distal anterior choroidal artery aneurysm because these aneurysms might grow and re-rupture in the short term.
authors.affiliation: Department of Neurosurgery, National Hospital Organization Himeji Medical Center.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ikeda
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamana
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hayashi
authors.forename: Taichi
authors.initials: T
authors.lastname: Ikedou
authors.forename: Yasuzumi
authors.initials: Y
authors.lastname: Matsui
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Hirose
authors.forename: Masaki
authors.initials: M
authors.lastname: Nishimura
authors.forename: Naoki
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Rei
authors.initials: R
authors.lastname: Enatsu
authors.forename: Masaaki
authors.initials: M
authors.lastname: Saiki
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D001921:Brain / Q000098:blood supply / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D016896:Treatment Outcome