Distal anterior choroidal artery aneurysm associated with an arteriovenous malformation. intraoperative localization and treatment

An 84-year-old woman with a history of hypertension and a brain infarction presented with a rare distal anterior choroidal artery (AChoA) aneurysm not associated with moyamoya disease manifesting as sudden onset of headache caused by intraventricular hemorrhage. Digital subtraction angiography revealed a peripheral aneurysm in the left AChoA located distal to the plexal point and steno-occlusive changes of the proximal left middle cerebral artery (MCA) and the left posterior cerebral artery (PCA).Collateral arterial channels to the left MCA and left PCA territories were observed along the left AChoA.No neuroimaging findings were compatible with moyamoya disease. Since the aneurysm did not shrink at 2 months after the onset, endovascular treatment was indicated. Under local anesthesia, a microcatheter was placed into the AChoA proximal to the aneurysm with the aid of a 0.008-inch microguidewire. After a provocation test, three detachable platinum coils were delivered into the aneurysm and the parent artery. Complete obliteration of the aneurysm was achieved without additional neurological sequelae. Successful treatment of a ruptured distal AChoA aneurysm associated with atherosclerotic changes of the intracranial arteries was achieved using a meticulous endovascular technique.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endovascular Coil Embolization of a Ruptured Distal Anterior Choroidal Artery Aneurysm Associated With Ipsilateral Middle Cerebral Artery Occlusion -Case Report-

Nishida

Tokunaga

Hishikawa

et al. 2011

“…In addition, the radiolucent head frame allows intraoperative angiography in every direction, as previously reported. [15][16][17][18][19][20][21] Therefore, although head frame fixation using pins seems a little invasive, there are a number of advantages.…”

Section: Discussionmentioning

confidence: 99%

Head and Neck Extension-Fixation With a Head Frame for Exposure of the Distal Internal Carotid Artery in Carotid Endarterectomy-Technical Note-

Takigawa

Yanaka

Yasuda

et al. 2003

Self Cite

Adequate exposure of the distal internal carotid artery (ICA) for carotid endarterectomy may be difficult to achieve because of the position of the mandible and associated soft tissues. A simple yet effective use of a head frame is described to gain several centimeters of exposure of the distal ICA. The patient's head and neck are fixed in an extension position using a radiolucent head frame. Nasotracheal intubation and secure taping of the chin are also employed to keep the mouth closed and to prevent the mandible from spontaneously hanging down. The head frame tightly fixes the patient's neck, so the mandible does not disturb the surgical field throughout the operation. This simple method maximizes exposure of the distal ICA. The radiolucent head frame also enables intraoperative angiography to confirm the patency of the ICA and the absence of flap formation. This simple technique is useful for exposing the distal ICA.

“…Intraoperative angiography is useful in the treatment of cerebrovascular diseases. [1][2][3]6,7,9,11,[16][17][18][19]21,28,32,[34][35][36][37] However, the value of intraoperative angiography in the treatment of unruptured cerebral aneurysm is unknown. We have employed digital subtraction angiography during the intraoperative assessment of various cerebrovascular procedures including microsurgical clipping of cerebral aneurysms, resection of arteriovenous malformations, and cerebral revascularization.…”

Section: Introductionmentioning

confidence: 99%

“…We have employed digital subtraction angiography during the intraoperative assessment of various cerebrovascular procedures including microsurgical clipping of cerebral aneurysms, resection of arteriovenous malformations, and cerebral revascularization. [34][35][36][37] Here, we report on our experience with intraoperative angiography in a series of 38 consecutive cases of unruptured cerebral aneurysms to determine whether the use of intraoperative angiography has a favorable impact on the outcome after surgical treatment of unruptured cerebral aneurysms. …”

Section: Introductionmentioning

confidence: 99%

Intraoperative Angiography Evaluation of the Microsurgical Clipping of Unruptured Cerebral Aneurysms.

Yanaka

Asakawa

Noguchi

et al. 2002

Self Cite

Intraoperative angiography evaluation of the clippings of cerebral aneurysms was investigated in a series of 38 consecutive patients with unruptured cerebral aneurysms to determine any favorable impact on the outcome. Unexpected findings including major arterial occlusion or residual aneurysm were identified. Specific variables such as the size and site of aneurysm were analyzed to determine the impact on clinical outcome and the incidence of clip modification. There were 11 large and 27 small aneurysms in this series. Mortality and permanent morbidity after microsurgical clipping were 0.0% and 2.6%, respectively. Unexpected angiographic findings necessitating clip repositioning consisted of residual aneurysm in two cases and distal branch occlusion or parent vessel stenosis in four. The need for clip modification was significantly higher for large than for small aneurysms (p ＝ 0.007), and the rate of clip adjustment increased with increasing aneurysm size (p ＝ 0.008). Intraoperative assessment prior to wound closure allows for the recognition and correction of defects and decreases the risk of postoperative complications. Intraoperative angiography may become important in the microsurgical clipping of unruptured cerebral aneurysms, especially large aneurysms.