J Cerebrovasc Endovasc Neurosurg.  2018 Mar;20(1):47-52. 10.7461/jcen.2018.20.1.47.

Anterior Choroidal Artery Aneurysms: Influence of Regional Microsurgical Anatomy on Safety of Endovascular Treatment

• Ghali MG
• Srinivasan VM
• Wagner KM
• Lam S
• Johnson JN
• Kan P

• KMID: 2422560
• DOI: http://doi.org/10.7461/jcen.2018.20.1.47

Abstract

Several anatomical variables critically influence therapeutic strategizing for anterior choroidal artery (AChA) aneurysms, and specifically, the safety of flow diversion for these lesions. We review the microsurgical anatomy of the AChA, discussing and detailing these considerations in the treatment of AChA aneurysms, theoretically and in the light of our recent findings.

Keyword

Anterior choroidal artery; Anatomy; Flow diversion; Pipeline; Endovascular

MeSH Terms

Aneurysm*
Arteries*
Choroid*

Figure

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  Fig. 1 Anterior choroidal artery course and relations viewed from inferiorly. (A) The right AChA arises from the posterior wall of the ICA above the origin of the PCoA and passes backward below the optic tract and lateral to the PCA. It ascends around the medial surface of the uncus as it travels posteriorly. (B) The posterior uncal segment has been retracted. The AChA passes above the posterior uncal segment and enters the temporal horn by passing through the choroidal fissure located between the thalamus above and fimbria of the fornix below. The lateral geniculate body forms the part of the thalamus above where the artery enters the choroidal fissure. The dentate gyrus is located at the lower edge of the fimbria. Reprinted with permission from reference 17. Olf. Tr. = FULL NAME; M1 = sphenoidal segment of middle cerebral artery; Car. A. = internal carotid artery; CN II = optic nerve; Lent. Str. A. = lenticulostriate arteries; P.Co.A = posterior communicating artery; Optic Tr. = optic tract; CN III = oculomotor nerve; P1 = pre-communicating segment of posterior cerebral artery; A.Ch.A = anterior choroidal artery; P2 = post-communicating segment of posterior cerebral artery; M.P.Ch.A = medial posterior choroidal artery; P.C.A. = posterior cerebral artery; Dent. Gyr. = dentate gyrus; Chor. Fiss. = choroidal fissure; Lat. Gen. Body = lateral geniculate body; Basal V = basal vein of Rosenthal; ICA = internal carotid artery.

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  Fig. 2 Anterior choroidal artery course and relations viewed from laterally and medially. (A) Lateral view. The right AChA arises above the origin of the PComA and passes upward and backward around the uncus to reach the temporal horn. (B) Medial view. The AChA pursues an angulated course, descending along the anterior segment of the uncus, but at the uncal apex, it turns sharply upward, reaching the upper part of the posterior uncal segment before entering the temporal horn. Reprinted with permission from reference 17. Basal V. = basal vein of Rosenthal; M.C.A. = middle cerebral artery; A.Ch.A. = anterior choroidal artery; P.Co.A = posterior communicating artery; Car. A. = internal carotid artery; S.C.A. = FULL NAME; CN III = oculomotor nerve; cating segment of anterior cerebral artery; Bas. A. = basilar artery; Temp. Horn = temporal horn of lateral ventricle; Ant. Seg. = anterior segment of uncus; A1 = pre-communicating segment of anterior cerebral artery; Parahippo. Gyrus = parahippocampal gyrus; Post. Seg. = posterior segment of uncus; P2 = second segment of posterior cerebral artery; PComA = FULL NAME.

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