A dissecting aneurysm of the distal medial lenticulostriate artery: Case report.

A dissecting aneurysm of the distal medial lenticulostriate artery: Case report.

World Neurosurg. 2015 Dec 15;

Authors: Saito A, Kon H, Nakamura T, Sasaki T

Abstract
BACKGROUND: Medial lenticulostriate artery (MLSA) aneurysms are rare; to our knowledge only 2 cases without an association with Moyamoya disease have been documented. We treated a ruptured dissecting aneurysm of the distal MLSA surgically using a tube retractor.
CASE DESCRIPTION: A 66-year-old woman suffered sudden-onset consciousness disturbance. Computed tomography showed diffuse subarachnoid hemorrhage and a dense intraventricular hematoma associated with acute hydrocephalus. She underwent emergent ventricular drainage. Angiography revealed a 3-mm distal MLSA aneurysm. On repeat angiographs the aneurysm had not disappeared. As the stenotic, narrow structure of the proximal portion of the MLSA disallowed the endovascular approach we performed direct surgery via the transventricular approach using a tube retractor. The aneurysm on the intraventricular surface of the anterior horn of the lateral ventricle adjacent to the caudate nucleus was exposed. We resected the aneurysm under transcranial motor-evoked potential monitoring because neck clipping would have endangered the patency of the MLSA. Her postoperative course was uneventful. The pathological diagnosis was ruptured dissecting aneurysm.
CONCLUSIONS: There is no definitive strategy to treat distal MLSA aneurysms. Our experience illustrates that natural healing of the vessel wall cannot be expected in all cases. Therefore, less invasive direct surgical- as well as endovascular treatment should not be ruled out in patients with ruptured distal MLSA aneurysms.

PMID: 26704207 [PubMed – as supplied by publisher]

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