Management of a ruptured intraventricular aneurysm arising from distal anterior choroidal artery (AChA): pediatric case
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CASE REPORT
Management of a ruptured intraventricular aneurysm arising from distal anterior choroidal artery (AChA): pediatric case report Pablo García Feijoo 1 & Javier Manuel Saceda Gutiérrez 1 & Remedios Frutos Martínez 2 Catalina Vivancos Sánchez 1 & Fernando Eliseo Carceller Benito 1
&
Miguel Sáez Alegre 1
&
Received: 24 April 2020 / Accepted: 9 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Intracranial aneurysms arising from the distal anterior choroidal artery (AChA) are uncommon entities, with less than 30 cases reported. A 4-year-old boy was admitted to the Emergency Department with a sudden onset of severe headache and vomiting. CT scan of the head showed signs of intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH). Cerebral angiography revealed a right AChA aneurysm arising from a distal intraventricular branch with an associated microarteriovenous malformation (microAVM). Following a multidisciplinary assessment, the patient underwent surgical clipping. An ipsilateral transcortical transparietal approach was utilized. Early postoperative deficits were not found, and good clinical and radiological outcomes were assessed at long-term follow-up. Postoperative cerebral angiography showed complete exclusion and resection of both aneurysm and AVM. Surgery for intracranial aneurysms in this location can be challenging; however, good surgical and neurological outcomes can be achieved. The present work highlights the value of multidisciplinary assessment in the decisionmaking process in complex pediatric neurovascular pathology, especially when facing rare cases like this one, which represents the youngest case of a ruptured distal AChA aneurysm reported in the literature. Keywords Anterior choroidal artery (AChA) . Aneurysm . Intraventricular . Pediatric
* Pablo García Feijoo [email protected] Javier Manuel Saceda Gutiérrez [email protected] Remedios Frutos Martínez [email protected] Miguel Sáez Alegre [email protected] Catalina Vivancos Sánchez [email protected] Fernando Eliseo Carceller Benito [email protected] 1
Neurosurgery Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
2
Neuroradiology Division, Radiology Department, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid, Spain
Abbreviations ACHA Anterior choroidal artery AVM Arteriovenous malformation CT Computed tomography GCS Glasgow Coma Scale ICA Internal carotid artery IVH Intraventricular hemorrhage MRI Magnetic resonance imaging SAH Subarachnoid hemorrhage WFNS World Federation of Neurosurgical Societies
Introduction Anterior choroidal artery (AChA) aneurysms are uncommon, representing 2–5% of intracranial aneurysms [3, 4, 7, 9]. Aneurysms arising from the distal portion of the vessel are considered even less frequent. A pediatric case of intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH) following an AChA
Childs Nerv Syst
aneurysm rupture is presented. This cas
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