DOI QR코드

DOI QR Code

Infundibular Widening of Angiographically Invisible Duplicate Anterior Choroidal Artery Mimicking Typical Anterior Choroidal Artery Aneurysm

  • Jaechan, Park (Department of Neurosurgery, Kyungpook National University) ;
  • Jong-Soo, Kim (Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University)
  • 투고 : 2022.03.02
  • 심사 : 2022.05.11
  • 발행 : 2023.01.01

초록

A diagnosis of an intracranial aneurysm depends on the angiographic configuration and should be cautiously differentiated from aneurysm mimics. In cases of duplicate anterior choroidal arteries (AChAs), infundibular widening of the distal minor AChA can be an aneurysm mimic. If the minor AChA with a smaller diameter is obscured angiographically due to poor contrast filling, an associated infundibular widening beside the proximal large AChA can misinterpreted as a typical AChA aneurysm in angiograms. The authors report on two such cases of duplicate AChAs with infundibular widening presenting like a typical AChA aneurysm in angiograms. Surgical exploration revealed a perforating artery emitting from the dome of the saccular lesion, confirming infundibular widening of a duplicate AChA. No reparative procedure was applied to the infundibular widening in a 48-year-old man, while two vascular outpouchings from the infundibular widening were clipped preserving the duplicate AChA in a 55-year-old woman.

키워드

참고문헌

  1. Chen CJ, Moosa S, Ding D, Raper DM, Burke RM, Lee CC, et al. : Infundibular dilations of the posterior communicating arteries: pathogenesis, anatomical variants, aneurysm formation, and subarachnoid hemorrhage. J Neurointerv Surg 8 : 791-795, 2016 https://doi.org/10.1136/neurintsurg-2015-011827
  2. Cho MS, Kim MS, Chang CH, Kim SW, Kim SH, Choi BY : Analysis of clip-induced ischemic complication of anterior choroidal artery aneurysms. J Korean Neurosurg Soc 43 : 131-134, 2008 https://doi.org/10.3340/jkns.2008.43.3.131
  3. Chung J, Park W, Hong SH, Park JC, Ahn JS, Kwun BD, et al. : Intraoperative use of transcranial motor/sensory evoked potential monitoring in the clipping of intracranial aneurysms: evaluation of false-positive and false-negative cases. J Neurosurg 130 : 936-948, 2018 https://doi.org/10.3171/2017.8.jns17791
  4. Endo S, Furuichi S, Takaba M, Hirashima Y, Nishijima M, Takaku A : Clinical study of enlarged infundibular dilation of the origin of the posterior communicating artery. J Neurosurg 83 : 421-425, 1995 https://doi.org/10.3171/jns.1995.83.3.0421
  5. Epstein F, Ransohoff J, Budzilovich GN : The clinical significance of junctional dilatation of the posterior communicating artery. J Neurosurg 33 : 529-531, 1970 https://doi.org/10.3171/jns.1970.33.5.0529
  6. Flamm ES : Other aneurysms of the internal carotid artery in Wilkins RH, Rengachary SS (eds) : Neurosurgery. New York : McGraw-Hill, 1996, pp2301-2310
  7. Friedman JA, Pichelmann MA, Piepgras DG, Atkinson JL, Maher CO, Meyer FB, et al. : Ischemic complications of surgery for anterior choroidal artery aneurysms. J Neurosurg 94 : 565-572, 2001 https://doi.org/10.3171/jns.2001.94.4.0565
  8. Furtado SV, Venkatesh PK, Hegde AS : Neurological complications and surgical outcome in patients with anterior choroidal segment aneurysms. Int J Neurosci 120 : 291-297, 2010 https://doi.org/10.3109/00207451003668390
  9. Irie T, Yoshitani K, Ohnishi Y, Shinzawa M, Miura N, Kusaka Y, et al. : The efficacy of motor-evoked potentials on cerebral aneurysm surgery and new-onset postoperative motor deficits. J Neurosurg Anesthesiol 22 : 247-251, 2010 https://doi.org/10.1097/ANA.0b013e3181de4eae
  10. Ito A, Sato K, Niizuma K, Endo H, Matsumoto Y, Tominaga T : Intraoperative motor-evoked potential monitoring during coil embolization for anterior choroidal artery aneurysms. Neuroradiology 64 : 1221-1229, 2022 https://doi.org/10.1007/s00234-021-02847-z
  11. Kang HS, Kwon BJ, Kwon OK, Jung C, Kim JE, Oh CW, et al. : Endovascular coil embolization of anterior choroidal artery aneurysms. Clinical article. J Neurosurg 111 : 963-969, 2009 https://doi.org/10.3171/2009.4.JNS08934
  12. Kim BM, Kim DI, Chung EC, Kim SY, Shin YS, Park SI, et al. : Endovascular coil embolization for anterior choroidal artery aneurysms. Neuroradiology 50 : 251-257, 2008 https://doi.org/10.1007/s00234-007-0331-0
  13. Kim BM, Kim DI, Shin YS, Chung EC, Kim DJ, Suh SH, et al. : Clinical outcome and ischemic complication after treatment of anterior choroidal artery aneurysm: comparison between surgical clipping and endovascular coiling. AJNR Am J Neuroradiol 29 : 286-290, 2008 https://doi.org/10.3174/ajnr.A0806
  14. Koike G, Seguchi K, Kyoshima K, Kobayashi S : Subarachnoid hemorrhage due to rupture of infundibular dilation of a circumflex branch of the posterior cerebral artery: case report. Neurosurgery 34 : 1075-1077, 1994 https://doi.org/10.1097/00006123-199406000-00020
  15. Kucukay F, Okten RS, Tekiner A, Dagli M, Gocek C, Bayar MA, et al. : Three-dimensional volume rendering digital subtraction angiography in comparison with two-dimensional digital subtraction angiography and rotational angiography for detecting aneurysms and their morphological properties in patients with subarachnoid hemorrhage. Eur J Radiol 81 : 2794-2800, 2012 https://doi.org/10.1016/j.ejrad.2011.10.006
  16. Lee YS, Park J : Anterior choroidal artery aneurysm surgery: ischemic complications and clinical outcomes revisited. J Korean Neurosurg Soc 54 : 86-92, 2013 https://doi.org/10.3340/jkns.2013.54.2.86
  17. Li J, Mukherjee R, Lan Z, Liu Y, He M : Microneurosurgical management of anterior choroidal artery aneurysms: a 16-year institutional experience of 102 patients. Neurol Res 34 : 272-280, 2012 https://doi.org/10.1179/1743132812Y.0000000008
  18. Morris P : Practical Neuroangiography, ed 2. Philadelphia : Lippincott Williams & Wilkins, 2007, pp338-339
  19. Nakagawa I, Park H, Kotsugi M, Motoyama Y, Myochin K, Takeshima Y, et al. : Diagnostic impact of monitoring transcranial motor-evoked potentials to prevent ischemic complications during endovascular treatment for intracranial aneurysms. Neurosurg Rev 44 : 1493-1501, 2021 https://doi.org/10.1007/s10143-020-01338-8
  20. Osborn AG : Diagnostic Cerebral Angiography, ed 2. Philadelphia : Lippincott Williams & Wilkins, 1999, pp272-273
  21. Papke K, Kuhl CK, Fruth M, Haupt C, Schlunz-Hendann M, Sauner D, et al. : Intracranial aneurysms: role of multidetector CT angiography in diagnosis and endovascular therapy planning. Radiology 244 : 532-540, 2007 https://doi.org/10.1148/radiol.2442060394
  22. Park J, Kang DH : Infundibular widening mimicking anterior communicating artery aneurysm: report of 2 cases. J Neurosurg 119 : 243-246, 2013 https://doi.org/10.3171/2013.3.JNS122058
  23. Piotin M, Mounayer C, Spelle L, Williams MT, Moret J : Endovascular treatment of anterior choroidal artery aneurysms. AJNR Am J Neuroradiol 25 : 314-318, 2004
  24. Saltzman GF : Infundibular widening of the posterior communicating artery studied by carotid angiography. Acta Radiol 51 : 415-421, 1959 https://doi.org/10.3109/00016925909171114
  25. Senturk C, Bandeira A, Bruneau M, Dewindt A, Baleriaux D, De Witte O, et al. : Endovascular treatment of anterior choroidal artery aneurysms. J Neuroradiol 36 : 228-232, 2009 https://doi.org/10.1007/BF00588138
  26. Shi WY, Li YD, Li MH, Gu BX, Gu JP : Differential diagnosis of infundibular dilation versus a small aneurysm of the internal carotid artery: assessment by three-dimensional rotational angiography with volume rendering. Neurol Sci 34 : 1065-1070, 2013 https://doi.org/10.1007/s10072-012-1182-y
  27. Song J, Lang L, Zhu W, Gu Y, Xu B, Cai J, et al. : Application of intraoperative motor evoked potential monitoring during giant internal carotid artery aneurysm surgery using prolonged temporary occlusion. Acta Neurochir (Wien) 157 : 1833-1840, 2015 https://doi.org/10.1007/s00701-015-2568-4
  28. Suzuki K, Kodama N, Sasaki T, Matsumoto M, Konno Y, Sakuma J, et al. : Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery. J Neurosurg 98 : 507-514, 2003 https://doi.org/10.3171/jns.2003.98.3.0507
  29. Trasi S, Vincent LM, Zingesser LH : Development of aneurysm from infundibulum of posterior communicating artery with documentation of prior hemorrhage. AJNR Am J Neuroradiol 2 : 368-370, 1981
  30. Wollschlaeger G, Wollschlaeger PB : The circle of Willis in Newton TH, Potts DG (eds) : Radiology of the Skull and Brain. St. Louis : CV Mosby, 1974, Vol 2, pp1171-1201
  31. Yasargil MG : Clinical considerations, surgery of intracranial aneurysms and results. New York : Thieme, 1984, pp99-108
  32. Yasargil MG, Yonas H, Gasser JC : Anterior choroidal artery aneurysms: their anatomy and surgical significance. Surg Neurol 9 : 129-138, 1978
  33. Yeon JY, Seo DW, Hong SC, Kim JS : Transcranial motor evoked potential monitoring during the surgical clipping of unruptured intracranial aneurysms. J Neurol Sci 293 : 29-34, 2010 https://doi.org/10.1016/j.jns.2010.03.013