Anterior Choroidal Artery Aneurysms: Influence of Regional Microsurgical Anatomy on Safety of Endovascular Treatment

Abstract The perforating branches of the internal carotid artery (ICA) were examined in 30 forebrain hemispheres. These branches were present in all the cases studied, and varied from 1 to 6 in number (mean, 3.1). Their diameters ranged from 70 to 470 Mm (mean, 243 Mm). The perforating branches arose from the choroidal segment of the ICA, that is, from its caudal surface (52.3%), caudolateral surface (34.1%), or caudomedial surface (13.6%). They rarely originated from the bifurcation point of the ICA (10%). The distance of the remaining 90% of the perforators from the summit of the ICA measured between 0.6 and 4.6 mm. The perforating branches most often originated as individual vessels, and less frequently from a common stem with another vessel or by sharing the same origin site with another perforator or with the anterior choroidal artery. The bifurcation of the ICA, which is a frequent site for cerebral aneurysms, is surrounded by many perforating branches. Hence, great care must be taken to avoid damage to these important vessels during operations in that region.

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Endovascular Treatment of Ruptured Kissing Aneurysms Arising From the Origin of the Anterior Choroidal Artery and an Aberrant Origin of the Premamillary Artery

World Neurosurgery ◽

10.1016/j.wneu.2020.05.037 ◽

2020 ◽

Vol 140 ◽

pp. 10-12

Author(s):

Yoshinobu Horio ◽

Kenji Fukuda ◽

Shintaro Yoshinaga ◽

Yuki Kozaki ◽

Dai Kawano ◽

...

Keyword(s):

Endovascular Treatment ◽

Anterior Choroidal Artery ◽

Anterior Choroidal ◽

Premamillary Artery ◽

Choroidal Artery

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Microsurgical anatomy of the anterior choroidal artery

Acta Neurochirurgica ◽

10.1007/bf01401968 ◽

1988 ◽

Vol 92 (1-4) ◽

pp. 19-28 ◽

Cited By ~ 37

Author(s):

S. Hussein ◽

R. R. Renella ◽

H. Dietz

Keyword(s):

Microsurgical Anatomy ◽

Anterior Choroidal Artery ◽

Anterior Choroidal ◽

Choroidal Artery

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Microsurgical anatomy of the cisternal anterior choroidal artery with special emphasis on the preoptic and postoptic subdivisions

Journal of Neurosurgery ◽

10.3171/2014.1.jns131325 ◽

2014 ◽

Vol 120 (5) ◽

pp. 1217-1228 ◽

Cited By ~ 12

Author(s):

Necmettin Tanriover ◽

Baris Kucukyuruk ◽

Mustafa Onur Ulu ◽

Cihan Isler ◽

Bulent Sam ◽

...

Keyword(s):

Operative Procedure ◽

Anterior Segment ◽

Optic Tract ◽

Cerebral Peduncle ◽

Microsurgical Anatomy ◽

Anterior Choroidal Artery ◽

Complicated Course ◽

Anterior Choroidal ◽

Choroidal Artery ◽

Perforating Arteries

Object The object of this study was to delineate the microsurgical anatomy of the cisternal segment of the anterior choroidal artery (AChA). The authors also propose a new classification of this segment on the basis of its complicated course within the carotid and crural cisterns in relation to important neurovascular structures, and the site of origin, course, and areas of supply of perforating arteries. Methods Thirty cadaveric cerebral hemispheres injected with colored latex were dissected under surgical magnification to view the cisternal segment of the AChA and its perforators. Fiber dissections using the Klingler technique were performed in two additional latex injected hemispheres to follow the penetration points, courses, and terminal areas of supply of perforating branches that arise from the cisternal segment of the AChA. Results The cisternal segment of the AChA was divided into pre- and postoptic parts that meet at the artery's genu, the most medial extension point of the cisternal segment where the artery makes an abrupt turn after passing under the optic tract. The preoptic part of the AChA extended from its origin at the inferomedial side of the internal carotid artery to the artery's genu, which is commonly located just inferomedial to the initial part of the optic tract. The postoptic part coursed within the crural cistern and extended from the genu to the inferior choroidal point. The genu of the AChA was 8 mm medial to the artery's origin and was located medial to the optic tract in 13% of the hemispheres. The postoptic part was longer than the preoptic part in all hemispheres and had more perforating arteries supplying critical deep structures (preoptic 3.4 per hemisphere vs postoptic 4.6 per hemisphere), and these results were statistically significant (p = 0.01). At the preoptic part, perforating arteries arose from the superolateral portion of the artery and coursed laterally; at the postoptic part, perforators arose from the inferomedial portion of the artery and coursed medially. Perforating arteries from both segments passed most commonly to the optic tract, followed by the anterior segment and apex of uncus in the preoptic part and the cerebral peduncle in the postoptic part. Conclusions Both parts of the cisternal segment of the AChA come into surgical view during surgeries for different pathologies in and around the perimesencephalic cisterns. However, attending to the artery's genu and defining pre- and postoptic parts during surgery may help the surgeon locate the origin and eventual course of these perforators, and even estimate the terminal areas of supply of most of the perforating arteries. The proposed classification system can prove helpful in planning any operative procedure along the crural cistern and may reduce the probability of inadvertent injury to perforating branches of the cisternal segment.

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Microsurgical anatomy of the upper basilar artery and the posterior circle of Willis

Journal of Neurosurgery ◽

10.3171/jns.1977.46.5.0563 ◽

1977 ◽

Vol 46 (5) ◽

pp. 563-578 ◽

Cited By ~ 254

Author(s):

Naokatsu Saeki ◽

Albert L. Rhoton

Keyword(s):

Posterior Part ◽

Pituitary Tumors ◽

Careful Consideration ◽

Circle Of Willis ◽

Microsurgical Anatomy ◽

Anterior Choroidal Artery ◽

Posterior Half ◽

Content Type ◽

Anterior Choroidal ◽

Choroidal Artery

✓ The microvascular anatomy of the posterior part of the circle of Willis, important in surgery of pituitary tumors and basilar aneurysms, was defined in 50 cadaver brains. Significant findings were as follows: 1) Anomalies of the posterior half of the circle of Willis were found in 46% of cases. 2) Hypoplastic P-1 (posterior cerebral segment) and posterior communicating segments gave origin to the same number and size of perforating arteries, having the same termination as normal-sized segments. Thus hypoplastic segments should be handled with care and divided to aid in exposure of the basilar bifurcation only after careful consideration. 3) An average of four perforating branches arose from P-1; most from the superior and posterior surfaces. No branches arose from the anterior surface of the basilar bifurcation. The most proximal P-1 branch originated 2 to 3 mm distal to the basilar bifurcation. It was most commonly a thalamoperforating artery. The largest P-1 branch was usually a thalamoperforating or a posterior choroidal artery. 4) An average of seven branches emerged from the superior and lateral surfaces of the posterior communicating artery. The anterior half was a richer source of perforators than the posterior half. The largest communicating branch in 80% of specimens supplied the premamillary area. 5) The anterior choroidal artery originated from the carotid artery on both sides in all cases. A double anterior choroidal artery was present in 4% of cases.

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Endovascular treatment of anterior choroidal artery aneurysms

Journal of Neuroradiology ◽

10.1016/j.neurad.2008.12.002 ◽

2009 ◽

Vol 36 (4) ◽

pp. 228-232 ◽

Cited By ~ 5

Author(s):

C. Senturk ◽

A. Bandeira ◽

M. Bruneau ◽

A. Dewindt ◽

D. Balériaux ◽

...

Keyword(s):

Endovascular Treatment ◽

Anterior Choroidal Artery ◽

Anterior Choroidal ◽

Choroidal Artery

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Microsurgical anatomy of the anterior perforating arteries

Journal of Neurosurgery ◽

10.3171/jns.1984.61.3.0468 ◽

1984 ◽

Vol 61 (3) ◽

pp. 468-485 ◽

Cited By ~ 144

Author(s):

Saran S. Rosner ◽

Albert L. Rhoton ◽

Michio Ono ◽

Margaret Barry

Keyword(s):

Cerebral Artery ◽

Internal Carotid ◽

Microsurgical Anatomy ◽

Anterior Choroidal Artery ◽

Content Type ◽

Anterior Choroidal ◽

Relationship Of ◽

The Relationship ◽

Choroidal Artery ◽

Perforating Arteries

✓ The anterior perforating arteries, the group of arteries that enter the brain through the anterior perforated substance (APS), were examined using × 3 to × 40 magnification in 50 cerebral hemispheres obtained from 25 adult cadavers. These arteries arose from the internal carotid, middle and anterior cerebral, and the anterior choroidal arteries. The carotid branches to the APS arose distal to the origin of the anterior choroidal artery. The anterior choroidal artery branches arose from the main or superior branch of the artery. The middle cerebral artery branches to the APS (the lenticulostriate arteries) arose from the M1 and M2 segments and were divided into medial, intermediate, and lateral groups, each of which had a characteristic configuration. The anterior cerebral artery branches arose from the A1 segment and from the recurrent artery. The internal carotid and anterior choroidal artery branches entered the posterior half of the central portion of the APS. The lenticulostriate branches entered the middle and posterior portions of the lateral half of the APS. The A1 segment gave rise to branches which entered the medial half of the APS above the optic nerve and chiasm. The recurrent artery sent branches into the anterior two-thirds of the full mediolateral extent of the APS. The relationship of these branches to the cerebral structures above the APS and to the common aneurysm sites is reviewed.

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