J Cerebrovasc Endovasc Neurosurg.  2017 Sep;19(3):196-200. 10.7461/jcen.2017.19.3.196.

Endovascular Treatment of a Fusiform Aneurysm Involving a Premammillary Artery Originating from the Internal Carotid Artery: A Case Report

• Choi SJ
• Oh SY
• Shim YS
• Hyun DK

• KMID: 2393502
• DOI: http://doi.org/10.7461/jcen.2017.19.3.196

Abstract

The premammillary artery (PMA) is a branch of the posterior communicating artery (PCoA). While the PMA is known to originate from the PCoA as demonstrated by most anatomical studies, it originates directly from the internal carotid artery in approximately 1% of patients. Cerebral aneurysms associated with the PMA have rarely been reported. We report an extremely rare case of a ruptured PMA aneurysm that was managed using endovascular treatment.

Keyword

Premammillary artery; Endovascular treatment; Aneurysm; SAH

MeSH Terms

Aneurysm*
Arteries*
Carotid Artery, Internal*
Humans
Intracranial Aneurysm

Figure

• 

  Fig. 1 Computed tomography (CT) of the brain demonstrating subarachnoid hemorrhage (SAH) within the basal cisterns with an intra-parenchymal hematoma observed extending to the left frontal lobe. A CT angiogram demonstrates a fusiform aneurysm involving the communicating segment of the right internal carotid artery.

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  Fig. 2 Digital subtraction angiography (DSA) reveals an aneurysm involving the proximal segment of an undefined parent artery (thick arrows) originating from the internal carotid artery (ICA). The parent artery originates from the ICA just proximal to the origin of the posterior communicating artery (PCoA). This parent artery shows a short course in its distal segment running toward the prepontine cistern in a medial-posterior direction. The artery does not form fenestrations with the PCoA and anterior choroidal artery and follows an independent course.

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  Fig. 3 An Excelsior SL-10 microcatheter (Stryker, Fremont, CA, USA) is navigated into the premammillary artery with its tip positioned in the aneurysm. The aneurysm is subsequently occluded using 2 detachable coils.

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  Fig. 4 Diffusion-weighted magnetic resonance imaging (MRI) performed on postoperative day 11 showing high signal intensity within the right hypothalamus and fronto-parietal lobe. A correlative apparent diffusion coefficient (ADC) hypointensity is demonstrated within the same area.

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