Anomalous arrangement of the origins of the anterior choroidal and posterior communicating arteries

Abstract

A case of anomalous origin of the anterior choroidal and posterior communicating arteries in a 36-year-old woman with aneurysmal subarachnoid hemorrhage is presented. Preoperative four-vessel angiography revealed a reverse relationship of these vessels, wherein the anterior choroidal artery origin was proximal to the origin of the posterior communicating artery. This arrangement is extremely rare; the only other reported case was in a patient undergoing angiography prior to acoustic neurinoma resection. It is believed that this is the first case reported in a patient with subarachnoid hemorrhage from rupture of an aneurysm arising from a vessel of such anomalous origin.

Anomalous Origin of the Anterior Choroidal Artery

“…Anomalous origin of the AChA from the ICA proximal to the PcomA must be very rare. To our knowledge, our case is the fourth case of such an anomalous AChA [10][11][12] . One case was found during routine angiography performed prior to resection of an acoustic neurinoma 10 .…”

“…One case was found during routine angiography performed prior to resection of an acoustic neurinoma 10 . The second was a case of subarachnoid hemorrhage resulting in rupture of an aneurysm arising from either the AChA or the PcomA whose origins from the ICA were transposed 11 . The third was found on MRA performed for evaluation of headache 12 .…”

Anomalous medial origin of the anterior choroidal artery with associated aneurysm

“…Anomalies of the origin of the AChA include transposition of the AChA and the PCoA [11][12][13], origin from the PCoA [3,4] or from the junction of the ICA and the PCoA, [3] and origin from the middle cerebral artery [3,4,7]. Anomalies of the AChA throughout its distal course have also been reported [7,8].…”

Transposition of Anterior Choroidal Artery and Posterior Communicating Artery Origin

“…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.…”