J Korean Neurosurg Soc.  2023 Jan;66(1):105-110. 10.3340/jkns.2022.0046.

Infundibular Widening of Angiographically Invisible Duplicate Anterior Choroidal Artery Mimicking Typical Anterior Choroidal Artery Aneurysm

• Park J
• Kim JS

• KMID: 2537854
• DOI: http://doi.org/10.3340/jkns.2022.0046

Abstract

A diagnosis of an intracranial aneurysm depends on the angiographic configuration and should be cautiously differentiated from aneurysm mimics. In cases of duplicate anterior choroidal arteries (AChAs), infundibular widening of the distal minor AChA can be an aneurysm mimic. If the minor AChA with a smaller diameter is obscured angiographically due to poor contrast filling, an associated infundibular widening beside the proximal large AChA can misinterpreted as a typical AChA aneurysm in angiograms. The authors report on two such cases of duplicate AChAs with infundibular widening presenting like a typical AChA aneurysm in angiograms. Surgical exploration revealed a perforating artery emitting from the dome of the saccular lesion, confirming infundibular widening of a duplicate AChA. No reparative procedure was applied to the infundibular widening in a 48-year-old man, while two vascular outpouchings from the infundibular widening were clipped preserving the duplicate AChA in a 55-year-old woman.

Keyword

Angiogram; Craniotomy; Intracranial aneurysm

Figure

• 

  Fig. 1. case 1. A : Two-dimensional digital subtraction angiography (2d-dSA) image suggesting a saccular aneurysm (arrow) arising from the internal carotid artery (IcA) at the origin of the anterior choroidal artery (AchA) (arrowheads). b : Volume-rendered three-dimensional (3d) rotational angiography image showing the origin of the AchA (arrowheads) at the base of the saccular lesion. c : Intraoperative photograph revealing a minor AchA emitting from infundibular widening with the major AchA at its base. d : Illustration corresponding to panel (c).

• 

  Fig. 2. case 2. A : Two-dimensional digital subtraction angiography image showing an anterior choroidal artery (AchA) aneurysm (arrow). b : Volumerendered 3-dimensional rotational angiography image showing the origin of the AchA (arrowheads) at the proximal base of the saccular lesion. c : Intraoperative photograph revealing a minor AchA emitting from the dome of the saccular lesion with the major AchA at its base. Vascular outpouchings are seen in two areas. d : Illustration corresponding to panel (c). e : Intraoperative photograph showing the aneurysm clips repairing the aneurysmal changes.

Reference

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