J Korean Neurosurg Soc.  2016 Jul;59(4):414-419. 10.3340/jkns.2016.59.4.414.

Usefulness of Motor-Evoked Potentials Monitoring for Neurosurgical Treatment of an Unusual Distal Anterior Choroidal Artery Aneurysm

• Champeaux
• Jecko V
• Eimer S
• Penchet G

• KMID: 2315981
• DOI: http://doi.org/10.3340/jkns.2016.59.4.414

Abstract

A 35 years old woman presented with an acute meningeal syndrome following an intra ventricular haemorrhage without subarachnoid haemorrhage. The angiography demonstrated a 6 mm partially thrombosed saccular aneurysm at the plexal point of the right anterior choroidal artery (AChoA). It was surgically approached inside the ventricle through a trans-temporal corticotomy. The aneurysm was excised after distal exclusion of the feeding artery under motor-evoked potentials monitoring. Of the 19 cases of distal AChoA aneurysm neurosurgical treatment, this is the only one performed under electrophysiology monitoring, a simple and safe method to detect and prevent motor tract ischemia. We discuss this rare case, along with a comprehensible review of the literature of the previous surgical cases of distal AChoA aneurysms.

Keyword

Anterior choroidal artery; Cerebral aneurysm; Motor evoked potentials; Neurosurgical treatment; Intra ventricular haemorrhage

MeSH Terms

Aneurysm*
Angiography
Arteries*
Choroid*
Electrophysiology
Evoked Potentials, Motor
Female
Humans
Intracranial Aneurysm
Ischemia
Methods

Figure

• 

  Fig. 1 A : Left carotid artery digital subtraction angiography, lateral images showing the distal anterior choroidal artery aneurysm (black arrow). B : Zoomed, anterior-lateral and selective view of the aneurysm. C : Hematoxylin-eosin-saffron staining ×4 of the aneurysm showing the lumen (*), the thrombus (black arrow) inside the aneurismal wall which is ruptured (white arrow).

• 

  Fig. 2 A : Per operative view after trans sulcal approach between the superior and the middle temporal gyrus showing the intra ventricular hematoma (black arrow). B : Removal of the clot making the ependyma (black star) and the choroid plexus (black arrow) visible. C and D : exposition of the aneurysm (white arrow) and the distal AChoA (black arrow). E and F: temporary clipping (gray arrow) of the AChoA (black arrow). G and H : definitive Weck clip (gray arrow) of the AChoA. AChoA : Anterior Choroidal Artery.

Reference

1. Butler AB, Partain RA, Netsky MG. Primary intraventricular hemorrhage. A mild and remediable form. Neurology. 1972; 22:675–687. PMID: 4673249.

2. Dolati P, Sutherland G, Wong J, Hudon M, Goyal M. Distal anterior choroidal artery aneurysm following iatrogenic posterior cerebral artery occlusion : a case report and review of literature. Acta Neurochir (Wien). 2012; 154:53–57. PMID: 22068715.

3. Furuse S, Matsumoto S, Tanaka Y, Ando S, Sawa H, Ishikawa S. [Moyamoya disease associated with a false aneurysm--case report and review of the literature]. No Shinkei Geka. 1982; 10:1005–1012. PMID: 7177326.

4. Hamada J, Hashimoto N, Tsukahara T. Moyamoya disease with repeated intraventricular hemorrhage due to aneurysm rupture. Report of two cases. J Neurosurg. 1994; 80:328–331. PMID: 8283274.

5. Hiraishi T, Fukuda M, Oishi M, Nishino K, Shinbo J, Sorimachi T, et al. Usefulness of motor-evoked potential monitoring during coil embolization of anterior choroidal artery aneurysms : technical reports. Neurol Res. 2011; 33:360–362. PMID: 21535934.

6. Hung KS, Lee TC, Lui CC. Aneurysm of superior branch of anterior choroidal artery mimicking carotid bifurcation aneurysm-case report. Acta Neurochir (Wien). 1996; 138:1464–1467. PMID: 9030355.

7. Inci S, Arat A, Ozgen T. Distal anterior choroidal artery aneurysms. Surg Neurol. 2007; 67:46–52. discussion 52. PMID: 17210297.

8. Kasamo S, Asakura T, Yamamoto Y, Kobayashi E. Unilateral moyamoya disease associated with multiple aneurysms. A case report and review of the literature. Neurol Med Chir (Tokyo). 1984; 24:30–34. PMID: 6204236.

9. Knuckey NW, Epstein MH, Haas R, Sparadeo F. Distal anterior choroidal artery aneurysm : intraoperative localization and treatment. Neurosurgery. 1988; 22(6 Pt 1):1084–1087. PMID: 3419573.

10. Lee YS, Park J. Anterior choroidal artery aneurysm surgery : ischemic complications and clinical outcomes revisited. J Korean Neurosurg Soc. 2013; 54:86–92. PMID: 24175021.

11. Lévêque M, McLaughlin N, Laroche M, Bojanowski MW. Endoscopic treatment of distal choroidal artery aneurysm. J Neurosurg. 2011; 114:116–119. PMID: 20540628.

12. Morandi X, Brassier G, Darnault P, Mercier P, Scarabin JM, Duval JM. Microsurgical anatomy of the anterior choroidal artery. Surg Radiol Anat. 1996; 18:275–280. PMID: 8983106.

13. Nakai H, Yamamoto K, Sako K, Tanikawa R, Kunimoto M, Hashimoto M, et al. [A ruptured aneurysm at the peripheral collateral circulation of the anterior choroidal artery in a patient with moyamoya disease : a case report]. No Shinkei Geka. 1992; 20:985–990. PMID: 1407365.

14. Nishihara J, Kumon Y, Matsuo Y, Sakaki S. A case of distal anterior choroidal artery aneurysm : case report and review of the literature. Neurosurgery. 1993; 32:834–837. discussion 837. PMID: 8492860.

15. Papo I, Salvolini U, Caruselli G. Aneurysm of the anterior choroidal artery with intraventricular hematoma and hydrocephalus. Case report. J Neurosurg. 1973; 39:255–260. PMID: 4719704.

16. Penchet G, Arné P, Cuny E, Monteil P, Loiseau H, Castel JP. Use of intraoperative monitoring of somatosensory evoked potentials to prevent ischaemic stroke after surgical exclusion of middle cerebral artery aneurysms. Acta Neurochir (Wien). 2007; 149:357–364. PMID: 17380251.

17. Shih P, Pinnaduwage T, Hu LS, Spetzler RF. A pediatric patient with a dissecting thrombotic anterior choroidal artery aneurysm : case report. Neurosurgery. 2010; 67:E518. PMID: 20644385.

18. Strully KJ. Successful removal of intraventricular aneurysm of the choroidal artery. J Neurosurg. 1955; 12:317–321. PMID: 14381939.

19. Wong GK, Boet R, Poon WS. Ruptured distal anterior choroidal artery aneurysm presenting with right intracerebral haematoma : clipping aided by subpial uncal resection. J Clin Neurosci. 2003; 10:689–691. PMID: 14592620.

20. Yanaka K, Tsuboi K, Fujita K, Aoki K, Takeuchi S, Anno I, et al. Distal anterior choroidal artery aneurysm associated with an arteriovenous malformation. Intraoperative localization and treatment. Surg Neurol. 2000; 53:546–551. PMID: 10940421.

21. Yoneoka Y, Ezuka I, Takai N, Oda T, Tamura T, Yamashita S. Ruptured distal anterior choroidal artery aneurysm presenting with casting intraventricular haemorrhage. Acta Neurochir (Wien). 1998; 140:185–189. PMID: 10399000.

22. Yurt A, Turan Y, Uçar K, Camlar M, Oran I. Ruptured distal anterior choroidal artery aneurysm. J Clin Neurosci. 2009; 16:132–134. PMID: 19013815.