Intraventricular aneurysm of the distal segment of the anterior choroidal artery: A case report and review of literature.

Anterior choroidal artery (AChA) aneurysms at the junction of the ICA and AChA are the most common AChA pathology, and they account for approximately 2-5% of all intracranial aneurysms; however, aneurysms of the distal segment of the (AChA) are extremely rare. We report a case of a 73-year-old male who presented with altered mental status. Non-contrast computed tomography (CT) of the head showed extensive intraventricular hemorrhage that is most intense in the right temporal horn. Initial computed tomography angiography (CTA) revealed a lobulated enhancing structure with a vascular pedicle in the right temporal horn. Digital substruction angiography (DSA) confirmed the presence of a ruptured aneurysm in the intraventricular segment of the AChA. The aneurysm was not amenable to endovascular treatment due to a stenotic proximal AChA. The patient underwent a right transtemporal transventricular approach and clip placement. To our knowledge, our report introduces the use of BrainPath for the first time for aneurysmal clipping involving the intraventricular AChA. This case emphasizes the consideration of intraventricular AChA aneurysms as a possible cause of intraventricular hemorrhage (IVH). We also review the current literature on AChA.

Author(s): Karrar Aljiboori B.S, Mohamed Abouelleil, Justin Singer

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