Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning

Abstract

<jats:p> Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). </jats:p><jats:p> A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). </jats:p><jats:p> Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms. </jats:p>

Rupture of lenticulostriate artery aneurysms

“…Although these modalities offer good sensitiv ity, 29 LSA aneurysms are nonetheless difficult to detect. Of the 46 cases reported in the literature, there were 8 CTA studies 4,7,8,16,19,22,39,43 of which 3 were negative 4,8,19 and 3 MRA studies 17,25,32 of which 1 was negative. 32 All 3 of our patients underwent MRI with an angiographic se quence during the acute phase of the hematoma, but only in 1 case was there evidence of a suspected aneurysm, which was later confirmed on angiography.…”

Primary intraventricular hemorrhage: Clinical features, risk factors, etiology, and yield of diagnostic cerebral angiography

“…[5,[8][9][10] In our series, three (11.1%) LSA aneurysms was the cause for PIVH. LSA aneurysm rupture more often results in parenchymal hemorrhage, [13] PIVH secondary to LSA rupture is extremely rare. [14] LSA aneurysm was not the cause of PIVH in other series, however, few case reports have been documented.…”

Lenticulostriate artery aneurysm presenting as primary intraventricular haemorrhage

“…Lenticulostriate perforating artery aneurysms are rare 3. Parenchymal haemorrhages are more commonly associated with LSA aneurysm rupture,4 but isolated (primary) intraventricular haemorrhages secondary to LSA rupture is extremely rare 5…”

“…Because of the relatively inaccessible location of these lesions for direct surgical or endovascular occlusion, conservative management may be a therapeutic option in patients with LSA aneurysm, and spontaneous resolution can be observed 5. Definitive treatment of LSA aneurysms involves both surgical and endovascular methods 4 7…”

“…Around 29 cases of aneurysm arising from LSA beyond its origin have been reported, and mostly present with intraparenchymal haemorrhage 4 8. LSAs are end arteries, small and fragile, and supply the basal ganglia and internal capsule.…”