J Cerebrovasc Endovasc Neurosurg.  2025 Mar;27(1):66-70. 10.7461/jcen.2025.E2024.09.007.

Ruptured aneurysm of the medial posterior choroidal artery in the pineal region: A rare location easily missed

• Hall S
• Wang D
• Suresh V
• Borg N
• Bulters D

• KMID: 2567045
• DOI: http://doi.org/10.7461/jcen.2025.E2024.09.007

Abstract

Aneurysms of the pineal region are rare and theoretically could arise from the medial posterior choroidal artery (MPChoA) or lateral posterior choroidal arteries (LPChoA). A 64-year-old lady with subarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) due to a ruptured MPChoA aneurysm was treated with microsurgical aneurysm excision via an occipital interhemispheric approach. This case demonstrates the importance of being mindful of rare aneurysm locations when initial vascular imaging in SAH appears normal.

Keyword

Medial posterior choroidal artery; Pineal region aneurysm; Ruptured Aneurysm; Subarachnoid haemorrhage

Figure

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  Fig. 1. (A) Unenhanced CT taken at presentation with slices through the tectum, (B) Unenhanced CT taken at presentation with slices through the calcified pineal gland. CT, computed tomography

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  Fig. 2. (A) Lateral view of left internal carotid artery injection (day 6), (B) Lateral view of left internal carotid artery injection (day 12).

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  Fig. 3. 3D rotational angiography on day 12 segmented to highlight the fetal posterior communicating, posterior cerebral, medial posterior choroidal arteries and the aneurysm.

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  Fig. 4. Operative view (left) and with indocyanine green (ICG) (right) showing Rhoton dissector (R) and sucker (S) retracting deep cerebral veins (V) to expose the medial posterior choroidal artery (MPChoA) and its aneurysm (An).

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