Aneurysms of ruptured distal anterior choroidal artery embolized using n-butyl cyanoacrylate: case report

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  • SHIMIZU Tatsuya
    Department of Neurosurgery, Gunma University Graduate School of Medicine
  • NAITO Isao
    Department of Neurosurgery, Geriatrics Research Institute and Hospital
  • MIYAMOTO Naoko
    Department of Neurosurgery, Geriatrics Research Institute and Hospital
  • SATO Koji
    Department of Neurosurgery, Gunma University Graduate School of Medicine
  • AISHIMA Kaoru
    Department of Neurosurgery, Gunma University Graduate School of Medicine
  • NAKATA Satoshi
    Department of Neurosurgery, Gunma University Graduate School of Medicine
  • YOSHIMOTO Yuhei
    Department of Neurosurgery, Gunma University Graduate School of Medicine

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Other Title
  • 破裂前脈絡叢動脈遠位部動脈瘤に対しNBCA塞栓術を行った2例
  • 症例報告 破裂前脈絡叢動脈遠位部動脈瘤に対しNBCA塞栓術を行った2例
  • ショウレイ ホウコク ハレツ ゼン ミャクラクソウドウミャクエンイブ ドウミャクリュウ ニ タイシ NBCA ソクセンジュツ オ オコナッタ 2レイ

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Objective: We describe the cases of two patients with ruptured aneurysms of the distal anterior choroidal artery (AChA) that were embolized using n-butyl cyanoacrylate (NBCA).<br>Case presentation: Patient 1. A 43-year-old female presented with intracerebral hemorrhage due to a ruptured distal AChA aneurysm located on collaterals running from the lateral posterior choroidal artery (LPChA) to the AChA. The internal carotid artery between the origin of the posterior communicating artery and the AChA was severely stenosed. A microcatheter was navigated into the LPChA via the posterior communicating artery and then 55% NBCA was injected during balloon occlusion at the origin of the LPChA. This strategy obliterated the aneurysm without complications.<br>Patient 2. A 6-year-old female presented with intracerebral hemorrhage due to a ruptured distal AChA aneurysm located on the plexal segment of the AChA, which was a feeding artery of an arteriovenous malformation. A microcatheter was navigated into the AChA beyond the junction of the LPChA. An injection of 25% NBCA obliterated the aneurysm and the arteriovenous malformation. Magnetic resonance imaging revealed asymptomatic infarction at the posterior thalamus.<br>Conclusion: Embolization of AChA beyond the plexal point is considered safe. However, NBCA migrating into the cisternal segment of the AChA and the occlusion of the perforating arteries supplying the thalamus from the plexal segment of the AChA confer a potential risk of infarction.

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