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Transposition of anterior choroidal artery and posterior communicating artery origin.
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MedLine Citation:
PMID:  23115668     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
The anterior choroidal artery has several kinds of variations. Among them, the transposition of anterior choroidal artery and posterior communicating artery origins has been extremely rare. We report a case with cerebral aneurysm arising from posterior communicating artery which origin was distal to the anterior choroidal artery and review the relevant literature.
Authors:
Chan Young Choi; Chae Heuck Lee
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Publication Detail:
Type:  Journal Article     Date:  2012-09-30
Journal Detail:
Title:  Journal of Korean Neurosurgical Society     Volume:  52     ISSN:  1598-7876     ISO Abbreviation:  J Korean Neurosurg Soc     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-11-01     Completed Date:  2012-11-02     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101467054     Medline TA:  J Korean Neurosurg Soc     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  240-2     Citation Subset:  -    
Affiliation:
Department of Neurosurgery, Ilsan Paik Hospital, Inje University, Goyang, Korea.
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Journal Information
Journal ID (nlm-ta): J Korean Neurosurg Soc
Journal ID (iso-abbrev): J Korean Neurosurg Soc
Journal ID (publisher-id): JKNS
ISSN: 2005-3711
ISSN: 1598-7876
Publisher: The Korean Neurosurgical Society
Article Information
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Copyright © 2012 The Korean Neurosurgical Society
open-access:
Received Day: 26 Month: 12 Year: 2011
Revision Received Day: 05 Month: 7 Year: 2012
Accepted Day: 17 Month: 9 Year: 2012
Print publication date: Month: 9 Year: 2012
Electronic publication date: Day: 30 Month: 9 Year: 2012
Volume: 52 Issue: 3
First Page: 240 Last Page: 242
PubMed Id: 23115668
ID: 3483326
DOI: 10.3340/jkns.2012.52.3.240

Transposition of Anterior Choroidal Artery and Posterior Communicating Artery Origin
Chan Young Choi, M.D.A1
Chae Heuck Lee, M.D.A1
Department of Neurosurgery, Ilsan Paik Hospital, Inje University, Goyang, Korea.
Correspondence: Address for reprints: Chan Young Choi, M.D. Department of Neurosurgery, Ilsan Paik Hospital, Inje University, 170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea. Tel: +82-31-910-7730, Fax: +82-31-915-0885, cychoi@paik.ac.kr

INTRODUCTION

The anterior choroidal artery (AchoA) supplies several important structures including the optic tract, geniculate body, posterior limb of internal capsule, globus pallidus, cerebral peduncle, uncus, amygdala, ventrolateral nucleus of thalamus, and choroid plexus. The vascular injury of AchoA may result in severe neurological deficits such as hemiplegia, hemianesthesia, hemianopsia, decreased consciousness, and extrapyramidal symptoms. Therefore, complete knowledge about vascular anatomy of AchoA is very important before surgical or endovascular manipulations. Although several detailed reports about anatomical variations of AchoA have been reported, transposition of AchoA as to posterior communicating artery (PcomA) origin was demonstrated only in 3 reports2-4). We report a case with ruptured cerebral aneurysm arising from PcomA, which originated from the internal carotid artery (ICA) distal to the origin of AchoA.


CASE REPORT

A 40-year-old woman presented with sudden onset of headache. Computed tomography (CT) revealed subarachnoid hemorrhage (SAH) which was slightly predominant in the left basal and sylvian cisterns. Two small aneurysms arose from both distal supraclinoid ICA, these were observed on CT angiograms (Fig. 1). Cerebral angiography demonstrated a small aneurysm arising from left fetal type of PcomA with suspicion of rupture and the other small aneurysm originating from right PcomA or perforating branch of ICA. In this study, left AChoA originated from ICA proximal to the origin of fetal type of PcomA (Fig. 2). The patient underwent neck clipping of left PcomA aneurysm. These findings were confirmed during operation (Fig. 3).


DISCUSSION

AchoA usually arises from the posterolateral wall of ICA, a few mm distal to the origin of PcomA, and it provides blood supply to the important neural structures around crural and ambient cisterns. These regions may also receive perforating branches arising from ICA frequently. The AchoA can have several variations in the course, size, number, branching pattern, and brain region supplied by this artery1). Among them, there have been several anomalies related to the origin of AchoA including transposition of AchoA and PcomA, origin from PcomA, origin from junction of ICA and PcomA, and origin from middle cerebral artery4,5). The clinical findings of transposed AchoA cases including present one are summarized in Table 1. All of the transpositions of AchoA occurred in the left side. Among all the cases, only two were associated with ipsilateral ruptured cerebral aneurysms arising from AchoA or PcomA. Another one had an ipsilateral unruptured AchoA aneurysm. Our case showed SAH due to ruptured aneurysm arising from fetal type of PcomA among multiple cerebral aneurysms founded and AchoA originating from ICA proximal to PcomA. The contralateral PcomA and AchoA were normal. Typically, AchoA runs posteromedially within the crural cistern and continues ambient cistern to enter the choroidal fissure. The proximal portion of this artery is cisternal segment and following portion becomes intraventricular segment1). The transposed AchoA in the previous cases including ours did not seem to affect the vascular territory or course despite of unusual vascular arrangements. The AchoA can be exposed or manipulated in surgical approaches into the pathological lesions around temporal lobe or involving supraclinoid ICA. Although the AchoA aneurysms accounting for 4% of all cerebral aneurysms are not so common, vascular injury of AchoA with small caliber supplying the eloquent areas may be critical because of the possibility of significant morbidity and mortality. And, another caution is that AchoA do not have significant collateral flows despite a potential anastomosis with posterior choroidal artery3). We tried to preserve PcomA itself and all perforating branches arising from it because of the possibility to compromise the collateral flows of fetal type PcomA.


CONCLUSION

It is notable that careful review of the preoperative angiograms helps to find unexpected vascular anomalies which may impose an additional surgical risk.


References
1. Baskaya MK,Coscarella E,Gomez F,Morcos JJ. Surgical and angiographic anatomy of the posterior communicating and anterior choroidal arteriesNeuroanatomyYear: 200433842
2. Hara N,Koike T,Akiyama K,Toyama M. Anomalous origin of anterior choroidal arteryNeuroradiologyYear: 198931882717012
3. Moyer DJ,Flamm ES. Anomalous arrangement of the origins of the anterior choroidal and posterior communicating arteries. Case reportJ NeurosurgYear: 199276101710181588407
4. Nomura M,Kida S,Kita D,Hasegawa M,Matsui O,Yamashita J. Anomalous origin of anterior choroidal artery associated with an aneurysmActa Neurochir (Wien)Year: 20001421067106811086819
5. Rhoton AL. Rhoton ALThe supratentorial arteriesCranial anatomy and surgical approachesYear: 2008BaltimoreLippincott Williams & Wilkins

Article Categories:
  • Case Report

Keywords: Cerebral aneurysm, Anterior choroidal artery, Posterior communicating artery, Transposition.

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